Life course rural-urban residence and multimorbidity among older adults in India

Indian adults problematic pornography use: psychological correlates and predictors

Research is needed to identify lipidomic markers associated with habitual physical activity (PA) among American Indian adults and examine their associations with diabetes risk. We performed LC-MS to quantify 1,542 fasting plasma lipids from 1,779 participants at baseline and 1,406 at follow-up (about 5.5-year apart). PA was objectively measured using pedometers at both visits. We identified lipids associated with PA using mixed-effects linear regression, adjusting for BMI and other covariates. Logistic and linear regression was used to evaluate the associations of PA-related lipids with incident diabetes/prediabetes and glucose/insulin metrics. Mediation role of lipids was examined. Among 1,047 participants with normal fasting glucose at baseline, 68 developed diabetes and 178 developed prediabetes. PA was associated with 127 lipids (q < 0.05), including positive associations with glycerophospholipids and inverse associations with triacylglycerols. Eighteen of the 36 annotated lipids were associated with incident diabetes/prediabetes, with 16 linked to lower PA and higher diabetes risk. Most PA-related lipids were also associated with changes in glucose/insulin metrics, and 28 lipids mediated the positive association between PA and insulin sensitivity. Overall, we identified lipidomic signatures of PA among American Indians. These lipids were associated with diabetes risk, potentially through mediating the protective effects of PA on insulin sensitivity.

The increasing emotional distress among emerging adults highlights the importance of examining trauma-related factors, particularly complex trauma. This study investigates post-traumatic stress disorder (PTSD), complex post-traumatic stress disorder (C-PTSD), and emotional distress, emphasizing the predictive role of disturbances in self-organization (DSO) as defined by the International Classification of Diseases (11th revision) (ICD-11). A cross-sectional study was conducted among 538 college-going emerging adults (aged 15-29 years). The study received ethical clearance from the institute and informed consent from the participants, who completed validated measures: the International Trauma Questionnaire and Depression, Anxiety, and Stress Scale-21. Quantitative data were analyzed using descriptive statistics, Mann-Whitney/Kruskal-Wallis tests, Pearson's correlation, and multiple linear regression. Thematic analysis was used to explore self-reported traumatic experiences. Prevalence rates were 15.2% for C-PTSD, 20.8% for PTSD, 53.9% for depression, 66.5% for anxiety, and 36.2% for stress. DSO showed the strongest associations with all three domains of emotional distress. Thematic analysis revealed multidimensional trauma themes, including career anxiety, relational issues, abuse, loss, and social exclusion. Gender and psychiatric history significantly moderated distress levels, while rural-urban background showed no difference. Among the variables, DSO demonstrated the strongest and most consistent associations with depression, anxiety, and stress, pointing to its close link with complex trauma responses. Results highlight the need for trauma-informed screening and interventions in Indian academic settings and support ICD-11's distinction between PTSD and C-PTSD. A tiered intervention model is recommended for early detection and tailored care.

Historical trauma and ongoing systemic inequities contribute to elevated levels of anxiety and problematic alcohol use among American Indians. The current study examines the relationship between recent trauma and problematic alcohol use, testing anxiety as a mediator and self-compassion as a moderator. A sample of 727 American Indian adults completed measures of recent traumatic experiences, anxiety, problematic alcohol use, and self-compassion. Results indicated that anxiety mediated the relationship between trauma and alcohol use, suggesting that individuals with greater recent trauma exposure engage in increased problematic drinking partly due to increased anxiety. Contrary to expectations, rather than buffering the impact of trauma on anxiety, self-compassion strengthened the trauma-anxiety link. The current findings highlight the complexity of self-compassion as a protective factor and suggest a context-dependent effect. Interventions should consider both cultural and emotional processing factors in utilizing self-compassion to address trauma-related alcohol use.

To identify factors associated with adherence to annual eye examinations among adults with diabetes mellitus (DM) in Malaysia. Data from community-dwelling adults aged ≥18y with known DM, defined as those who had previously been informed by a doctor or assistant medical officer of their diagnosis were analyzed using the National Health and Morbidity Survey 2023, a population-based cross-sectional survey conducted using a two-stage stratified random sampling design. Locally validated questionnaire on diabetic eye screening was administered through face-to-face interviews from July until September 2023. Adults with known DM were asked three key questions about eye examinations: whether their eyes had been examined using clinical tools (illustrated with images of a direct ophthalmoscope, slit lamp or fundus camera), the timing of their last eye examination (if applicable), and whether they had been referred to an ophthalmology clinic for DM-related complications, serving as a proxy for diabetic retinopathy (DR) referrals. Complex sample analysis, incorporating sample weights and the study's design, were used to describe respondents' baseline characteristics by urban or rural localities. Multivariable binary logistic regression with adjusted odds ratio (aOR) and 95% confidence interval (CI) was performed. Among 1554 adults with known DM in Malaysia, 58.8% had never undergone an eye examination and only 29.5% complied with the recommended annual eye check-ups. Additionally, 25.8% of DM patients were referred to an ophthalmology clinic for DR. Referral to ophthalmology clinic for DR (aOR=4.63, 95%CI: 3.27, 6.55), insulin use (aOR=1.93, 95%CI: 1.37, 2.72), secondary education (aOR=1.71, 95%CI: 1.03, 2.85) and DM duration ≥10y (aOR=1.48, 95%CI: 1.02, 2.16) were associated with higher odds of annual eye examinations. Chinese (aOR=0.50, 95%CI: 0.29, 0.87) and Indian (aOR=0.47, 95%CI: 0.29, 0.78) ethnicities had lower odds of undergoing annual eye examinations compared to Malay ethnicity. Similarly, those with a monthly household income of ≥RM10 000 (aOR=0.45, 95%CI: 0.21, 0.95) were less likely to get their eyes examined yearly. Fewer than one-third of adults with DM in Malaysia adhere to the recommended annual eye examinations, with lower compliance observed among Chinese or Indian ethnicities and those with higher household incomes. Targeted educational campaigns for Chinese, Indian, and higher-income adults with DM may encourage regular eye exams and reduce preventable vision loss from DR in Malaysia.

Objectives: The present study aimed to explore the relationship between the family environment at home and personal values of Indian young adults. Further, it also examined the role of family environment in predicting and influencing the development of their values. Methods: Employing a cross-sectional study design, data were collected from 385 college students (18-20 years old) during April 2023-May 2024, residing in the Indian cities of Ahmedabad and Jaipur through a survey method. The participants were administered a demographic information sheet, the family environment scale, and the twenty-item value inventory to assess the family environment and personal values of the young adults. The data was analysed for descriptive statistics, bivariate correlation, and regression analysis. Findings: The results revealed significant relationships between the family environment and the values of the participants. For instance, benevolence showed a positive, but weak, correlation with all dimensions of the family environment, specifically cohesion (r = 0.13, p &lt; 0.05), expressiveness (r = 0.21, p &lt; 0.01), etc. Similarly, values of universalism and self-direction showed a positive and significant correlation with all the dimensions of family environment. Regression analysis indicated that a cohesive and caring family environment, which provides enough space for expression of emotions, plays a pivotal role in nurturing values such as benevolence (adj. R2= .148), having a sense of self-direction (adj. R2= .208), universalism (adj. R2= .131), and security (adj. R2= .155) among young adults. Novelty: The study demonstrates how different aspects of family, and its environment can either support or discourage the development of certain values. It offers valuable insights that are relevant to the real-life challenges faced by young adults in the fast-changing social landscape. Keywords: Home environment, Sustainable family, Young adults, Benevolence, Universalism, Stress-resistant

There are close to 100 million combustible tobacco users in India. This study was conducted to assess the national and state-level estimates for smoking quit ratio and identify the factors associated with quitting smoking among life-time combustible tobacco users aged 45 years and above in India. A cross-sectional analysis of a representative sample of 11,920 lifetime combustible tobacco users aged ≥ 45 years extracted from the Longitudinal Ageing Study in India (LASI) was conducted. Quit ratio was defined as the ratio of individuals who quit smoking to lifetime combustible tobacco users. Descriptive estimates for quit ratios at the national and state levels were computed. Adjusted odds ratios (AOR) using binary logistic regression analysis were computed to identify the factors associated with quitting smoking. The smoking quit ratio at the country level was estimated as 21.1%. Among major states, Kerala (49.0%, 95% CI = 48.9–49.1) had the highest quit ratio. Individuals aged 61 years and above (AOR = 1.72; 95% CI = 1.46–2.03), healthcare visits (AOR = 1.29; 95% CI = 1.09–1.53), diagnosis with non-communicable diseases like cancer, lung disease, heart disease or stroke (AOR = 1.87, 95% CI = 1.52–2.30) had significantly higher odds of successfully quitting smoking. Individuals consuming alcohol at least once a month (AOR = 0.55; 95% CI = 0.42–0.71) had lower odds of quitting smoking compared to their counterparts. The less-than-optimal quit ratios at national and state levels among lifetime combustible tobacco users in India are reflective of the bottlenecks in tobacco cessation support availability, access, and use. A higher quit ratio was observed in states that invested in strengthening tobacco control systems.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-23584-w.

The prevalence and severity of Obstructive Sleep Apnea(OSA) vary by ethnicity, yet data comparing OSA and its anthropometric risk factors across global, population-based cohorts remain limited. We aimed to determine associations between morphological factors and OSA severity, as well as whether OSA-related cardiometabolic risks differ among Swiss, Beninese, and Indian adults. We analyzed pooled data from 4,663 adults enrolled in three population-based sleep cohorts: HypnoLaus(Switzerland), BeSAS(Benin), and BLESS(India). Associations between OSA severity (apnea-hypopnea index, AHI) and anthropometric measures [body mass index (BMI), neck circumference, and waist circumference] were examined using multivariable regression models adjusted for age and sex, with effect modification by cohort assessed. Associations between OSA (AHI ≥ 15) and major cardiometabolic comorbidities (hypertension, diabetes, and metabolic syndrome) were also evaluated. For each 1 Kg/m2 increase in BMI, AHI increased by 5.95%, 7.31%, and 8.06% in Beninese, Swiss, and Indians, respectively. OSA was consistently associated with increased odds of hypertension in all populations (OR: 1.30, 1.76, and 1.63 in Swiss, Indian, and Beninese populations, respectively). Moreover, OSA was associated with increased odds of metabolic syndrome [in Swiss (OR:1.64) and Indian (OR: 1.89)]. Associations between obesity-related anthropometric factors, OSA severity, and cardiometabolic comorbidities differ across populations, with the strongest relationships observed in the Indian and Swiss cohorts. These findings underscore the importance of population-specific risk stratification and highlight the need to consider local anthropometric and epidemiologic contexts in OSA management and prevention strategies.

Physical activity (PA) is a significant predictor of physical and mental health, particularly among older adults. In India and China, gendered social norms shape physical patterns, and the intensity of androcentric settings is different. As a result, the gendered perspective of physical activity and its association with health outcomes could be different in China and India. Therefore, the study examines gender differences in physical activity and their impact on health outcomes. This study utilizes nationally representative data from older adults aged 60 and above in India and China. Gender disaggregated physical activity is considered a key explanatory variable, and functional limitations (IADL/ADL), multimorbidity, and self-rated health are selected as outcome variables. Separate logistic regression analyses were conducted for males and females to examine the gender-specific associations between PA and health. Indian women show lower moderate PA (54.58%) than Chinese women (49.99%), with markedly fewer engaging in intense PA (12.35% vs. 24.01%). Health disparities are more severe in India: 56.15% report IADL limitations (China: 42.86%) and 25.2% ADL problems (China: 29.09%). While moderate PA strongly protects against poor SRH/ADL in both countries, Indian women face higher multimorbidity risks (aOR: 1.38 vs. China's Non-Significant) when inactive. This comparative study reveals that Indian women face greater physical activity disparities and worse functional health outcomes than Chinese women, highlighting the urgent need for gender-sensitive health interventions to address these inequities.

Common mental disorders (CMDs) in older adults contribute to considerable disease burden and are associated with significant multimorbidity. With the increase in population ageing, the concerns related to multimorbidity are likely to increase. Cognitive-behavioural therapy (CBT) is an evidence-based approach for CMDs. More recently, transdiagnostic approaches to address shared mechanisms across disorders have been studied. Novelty: Despite a considerable body of literature on psychological interventions in higher-income countries, there is a notable lack of empirical studies examining the efficacy of transdiagnostic CBT (tCBT) in CMDs and older adults in India. In this study, we propose to test the effectiveness of a tCBT adapted for older adults, involving stakeholders. To examine the efficacy of a tCBT for older adults with CMDs. A two-group parallel-arm randomised controlled design will be adopted to examine the efficacy of tCBT in older adults with CMDs. A total of 120 older adults (N = 60; intervention and control arm, respectively), meeting criteria for CMDs and scoring above the cut-off on Patient Health Questionnaire-9 and/or GAD-7, consenting for participation, will be randomised to receive either tCBT or treatment as usual plus psychoeducation (TAU + psychoeducation). The primary outcome (mood) will be measured using HAM-A and HAM-D. Secondary outcomes include sleep disturbances, repetitive negative thinking (RNT), metabolic effects, and quality of life. Participants will be assessed at baseline, post-intervention, and 3-month follow-up. The intervention will be adapted to older adults in India, based on a needs analysis with stakeholders (patients, caregivers, and experts). There is a dearth of systematic studies in India on psychotherapy in older adults, particularly those that target multimorbidity and transdiagnostic processes such as sleep and RNT. This psychotherapy trial will provide important empirical data on the efficacy of evidence-based tCBT in older adults with CMDs.

I ntroduction: Arterial stiffness and central arterial pressure are independent predictors of cardiovascular morbidity and mortality, with central pressure offering prognostic value beyond peripheral blood pressure (BP). While current guidelines recommend initiating treatment with single-pill combinations (SPCs), but the comparative effects of these combinations on arterial stiffness and central BP remain unclear, and no randomized evidence exists demonstrating their superiority, particularly in South Asian populations. This sub-study of the TOPSIN Trial aimed to evaluate the impact of three SPCs on aortic stiffness and central BP in Indian hypertensive patients. Methods: This is a triple-blind, randomized, three-arm trial involving 210 hypertensive patients aged 30–79 years. Participants were randomized in a 1:1:1 ratio to receive one of the following SPCs: amlodipine + perindopril (AM+PE), perindopril + indapamide (PE+ID), or amlodipine + indapamide (AM+ID). Eligible patients had clinic SBP≥140 and &lt;160 mmHg on one antihypertensive or SBP ≥150 and &lt;180 mmHg with no prior treatment. The study assessed central arterial stiffness- carotid-femoral pulse wave velocity (cf-PWV), carotid β-stiffness index (SI beta); carotid systolic (cSBP), diastolic (cDBP), and pulse pressure (cPP) using validated vascular analyzer (ArtSens-Plus, India). Secondary measures included 24-hour ambulatory BP (24ABPM), plasma nitric oxide concentration (NOx), and oxidative stress markers. SPCs were initiated at standard doses with forced up-titration at 2 months, and efficacy was assessed at 6 months. Results: Of the 210 randomized participants, 184 (38.0% women) aged 51±9.89 years were included in the final analysis. The mean 24h ambulatory SBP was 137.5±15.4 mmHg, and DBP was 85.3±9.1 mmHg. 53.3% had a history of hypertension, and 16.3% had diabetes. All three SPCs significantly reduced central and peripheral BP (p&lt;0.001), but no significant between-group differences were observed. There were no significant changes in arterial stiffness. However, AM+PE and PE+ID combinations significantly improved NOx levels (p&lt;0.01), while oxidative stress and antioxidant capacity remained unchanged across groups. Conclusion: All three single-pill combinations effectively reduced central and peripheral BP in Indian hypertensive patients, with no significant differences in arterial stiffness. Combinations containing perindopril improved nitric oxide levels, suggesting additional vascular benefits.

Introduction: Obesity-related cardiovascular (CV) risk is a growing concern in India, even in the absence of diabetes. Lifestyle intervention strategies may play a role in improving cardiovascular risk in the Indian population. Research Question: Does a structured, multidisciplinary lifestyle intervention improve CV risk factors—including the Atherogenic Index of Plasma (AIP) and estimated 10-year cardiovascular risk using the Framingham Risk Score (FRS)—in metabolically at-risk individuals with obesity? Methods: This study involved 271 adults, aged 30 to 75 years, with obesity (BMI ≥ 25 kg/m^2 according to the WHO Asia Pacific Guidelines) and no history of heart disease. These individuals participated in a one-year online intensive lifestyle intervention program at an obesity management clinic in Pune, India, between 2021 and 2023. The intervention comprised a personalized plant-based diet, physical activity, stress management, and medical management. Baseline and endline assessments were conducted to measure anthropometric and biochemical parameters related to cardiovascular risk. Results: The mean age of the cohort was 48.1±9.1 years, with 73.1% being female. Initially, 25.5% and 27.3% of the participants were receiving pharmacological treatment for dyslipidemia and hypertension, respectively. Post-intervention, there was a statistically significant improvement in weight loss (-6.5%, p&lt;0.005), with 14% of individuals transitioning to an overweight or normal BMI category. Notable improvements were observed in traditional risk factors: the prevalence of high triglycerides (≥150 mg/dl) decreased from 30% to 23.6%, high non-HDL cholesterol (≥130 mg/dl) from 67.2% to 60.5%, low HDL cholesterol in females (≤50 mg/dl) from 61.1% to 53.0%, and a high TG/HDL ratio (≥3) from 38.0% to 31.4% (p&lt;0.05). Among non-traditional risk factors, the proportion of individuals with high-sensitivity C-reactive protein (hs-CRP &gt;3 mg/L) decreased from 57.9% to 41.7% (p&lt;0.05). The intervention led to a significant reduction in the AIP, with the percentage of individuals exceeding the risk threshold (&gt;0.11) decreasing from 40.0% to 33.6%. Furthermore, the estimated 10-year cardiovascular risk, as assessed by the FRS, demonstrated a significant improvement (-7.6%, p&lt;0.001). Conclusion: A one-year online lifestyle intervention significantly improved traditional and non-traditional CV risk factors, reducing AIP and FRS scores in obese Indian adults.

Background: Non-dipping and reverse-dipping of nocturnal blood pressure (BP) are associated with increased cardiovascular risk. Data on dipping status and its modulation by Single-Pill Combination (SPC) therapy in Indian or South Asian populations is sparse. Objectives: To evaluate the prevalence and predictors of nocturnal BP dipping patterns in Indian hypertensive patients and the efficacy of three SPCs on restoring dipping status. Methods: TOPSPIN was a multicenter, randomized, single-blind trial of 1981 Indian adults with hypertension, treated with three SPCs: amlodipine–perindopril, perindopril–indapamide, and amlodipine–indapamide. Ambulatory BP monitoring (ABPM) was performed at baseline (n=1980) and 6 months (n=1624). Dipping was defined by percent nocturnal systolic BP fall: extreme dipper (≥20%), dipper (10 - 20%), non-dipper (&lt;10%), and reverse dipper (no fall or a paradoxical rise). Logistic regression identified predictors of non-dipping. Results: Among the 1980 participants with baseline ABPM data, 53.1% were classified as non-dippers, including 15.8% with a reverse-dipping pattern. Compared to dippers, non-dippers were older (53.2 vs. 50.8 years, p&lt;0.001), more likely to be female (46.2% vs. 37.4%, p&lt;0.001), have diabetes (20.8% vs. 16.3%, p=0.010) and have lower eGFR (92.5 vs 96.1 ml/min, p&lt;0.001). Non-dippers had significantly higher mean 24-hr ambulatory SBP, DBP, mean night-time SBP and DBP. Multivariable logistic regression showed that non-dipping was independently associated with age &gt;55 years (OR 1.42; 95% CI: 1.17–1.72), female sex (OR 1.44; 95% CI: 1.19–1.74), diabetes (OR 1.40; 95% CI: 1.10–1.79), current smoking (OR 1.66; 95% CI:1.12–2.46), and serum sodium &gt;140 mmol/L (OR 1.24; 95% CI: 1.02–1.52). For the patients (n = 1624) with complete baseline and 6-month ABPM data, the prevalence of non-dippers (non and reverse dippers) modestly declined from 53.1% to 49.5% (p=0.024). However, when stratified by treatment arm, the proportion of non-dippers at 6 months was 51.4% in the amlodipine–perindopril group, 47.8% in the perindopril–indapamide group, and 49.1% in the amlodipine–indapamide group with no significant between-group difference (p = 0.49). Conclusions: Non-dipping is highly prevalent among Indian hypertensive patients. Six months of SPC reduced overall BP but had a clinically minimal impact on restoring nocturnal dipping, with no significant differences across treatment arms.

Background: Diabetes mellitus represents a critical public health emergency in India, with projections indicating 134 million affected adults by 2045 (Pradeepa et al., 2020). The integration of machine learning with nationally representative survey data offers promising approaches for population-level risk stratification in resource-constrained settings. Methods: Utilizing the National Family Health Survey-5 (NFHS-5) dataset comprising 724,115 women and 101,839 men, this study implemented six machine learning algorithms. Comprehensive preprocessing addressed complex survey design and missing data through multiple imputation techniques (Van Buuren, 2018). Results: Ensemble methods demonstrated superior performance, with Random Forest achieving AUC-ROC 0.891 (95% CI: 0.884-0.898) and XGBoost 0.874 (95% CI: 0.866-0.882). The models identified age (22.3%), BMI (18.7%), and waist-to-hip ratio (15.2%) as primary predictors, consistent with known pathophysiological mechanisms while revealing novel socioeconomic determinants. Conclusion: Machine learning algorithms effectively predict diabetes risk using nationally representative data, potentially enabling cost-effective screening strategies. Implementation research is needed to translate these findings into public health practice..

Treatment gap and care characteristics for mental disorders among older adults in India: Evidence from National Mental Health Survey 2015-16.

Household pollutants, housing condition and cataracts among older adults in India: A rural-urban perspective

Novel genetic variants associated with stable isotope-based vitamin B12 bioavailability measurements in healthy Indian adults.

Background and Purpose Early‐onset stroke carries profound health and socioeconomic consequences and is an escalating concern owing to increased cardiovascular risk in young adults. This study explores lifestyle and comorbid risk‐factors in predicting stroke occurrence and analyzes post‐admission blood markers to reveal acute‐phase metabolic and inflammatory dysregulation in stroke among young Indian adults. Methods Unicentric case‐control study of 40 cases of imaging confirmed acute stroke and 81 sex‐matched controls all aged ≤45. Self‐reported demographic, lifestyle and comorbidity history, and laboratory reports within 6‐8 hours post‐admission were collected. Conditional and multivariate logistic regression estimated stroke odds associated with risk‐factors, and age‐ and sex‐stratified analyses explored clustering of risk and pathophysiological derangements among subgroups. Results Hypertension (OR:22.0, p&lt;0.001) and regular alcohol consumption (OR:6.7, p=0.047) independently conferred the strongest stroke odds. The youngest subgroup (15‐30years) carried 17‐fold higher odds with alcohol use (p=0.024) and had elevated bilirubin (p=0.014). Elevated WBC, creatinine, PPBS, and hyponatremia were found among cases, with females exhibiting higher platelets (p=0.002), depressed ALT (p=0.010), and males, elevated hemoglobin (p=0.027). Significant risk‐factor clustering was found between hypertension and diabetes among male and female cases (p=0.027, p=0.041) with complete concomitance of smoking and alcohol use in male cases and controls (p=0.031, p=0.012). Conclusions This study compellingly identifies hypertension and alcohol use as major, independent predictors of early‐onset stroke, underscoring distinct pathogenesis in this cohort and the urgent need for early detection, aggressive management and behavioral modification. Stratified analyses further unveiled novel insights on age‐ and sex‐specific heterogeneity in risk‐profiles and pathophysiology.

PurposeTo explore feasibility of using a Nurse Cancer Care Coordinator (CCC) to synthesize cancer survivorship care data, assess degree of cancer-related distress, and coordinate care for American Indian (AI) patients seen in a tribal primary care clinic.MethodsA CCC from one of Choctaw Nation’s primary care facility collected data on American Indian adults who had completed cancer treatment within the preceding five-years. Measures included demographics, cancer type, treatment and potential adverse effects, schedule of follow-up visits, behavioral risk assessment, global distress and checklist of distress sources, and length of time and frequency of attempts to complete data collection.ResultsNone of the participants had ever received a survivorship care plan (SCP). A total of 15 oncology providers were contacted to gather SCP and Distress Thermometer (DT) information on the 23 participants. Time to complete the SCP ranged from 30 to 120 min, with an average of 62 min per participant. The baseline DT score was 4.4 out of 10 and the average number of problems reported was 5.0. The top five challenges experienced by participants were fatigue (57%), pain (57%), worry (48%), tingling in hands/feet (33%), and sleep (33%).ConclusionsA Nurse CCC embedded within a tribal clinic organized clinically relevant survivorship care information, but this was a labor-intensive undertaking. Further work is needed to determine if risk stratification could be used to identify subsets of patients who would most benefit from this intervention.Implications for cancer survivors: Enhancement of Primary Care and Oncology communication may improve survivor care and health outcomes.