National Health Interview Survey Dataset Research Articles

Differences in modifiable cancer risk behaviors by nativity (US-born v. Non-US-born) and length of time in the US.

Previous studies have identified racial-ethnic disparities in modifiable risk factors for cancers. However, the impact of US nativity on these risks is understudied. Hence, we assessed the association between US nativity and length of time in the US on modifiable cancer risk factors. Utilizing the 2010 and 2015 National Health Interview Survey datasets, we analyzed 8,861 US-born and non-US-born adults. Key variables included age, sex, race-ethnicity, education, income, diet, body mass index, physical activity, alcohol consumption, and smoking. Statistical methods included descriptive statistics and regression. Most respondents were US-born (n = 7,370), followed by long-term (≥15 years, n = 928), and recent (<15 years, n = 563) immigrants. Moderate-to-vigorous physical activity was higher among US-born individuals (342.45 minutes/week), compared to recent (249.74 minutes/week) and long-term immigrants (255.19 minutes/week). Recent immigrants consumed more fruits (1.37 cups/day) and long-term immigrants more vegetables (1.78 cups/day) than US-born individuals. Multivariate analyses found recent immigrants had lower odds of consuming alcohol (AOR: 0.33, 95% CI: 0.21-0.50) and smoking (AOR: 0.30, 95% CI: 0.19-0.46), and higher odds of meeting fruit consumption guidelines (AOR: 2.80, 95% CI: 1.76-4.45) compared to US-born individuals. Long-term immigrants had lower odds of alcohol consumption (AOR: 0.56, 95% CI: 0.37-0.84) and smoking (AOR: 0.42, 95% CI: 0.30-0.59), and higher odds for meeting fruit (AOR: 1.87, 95% CI: 1.22-2.86) and fiber (AOR: 2.03, 95% CI: 1.02-4.05) consumption guidelines. Our findings illustrate the importance of considering the impact nativity and length of US residency has on health. Our findings underscore the need for culturally tailored public health strategies.

The long-term intercorrelation between post-burn pain, anxiety, and depression: a post hoc analysis of the “RE-ENERGIZE” double-blind, randomized, multicenter placebo-controlled trial

BackgroundDespite the growing prevalence of burn survivors, a gap persists in our understanding of the correlation between acute burn trauma and the long-term impact on psychosocial health. This study set out to investigate the prevalence of long-term pain and symptoms of anxiety and depression in survivors of extensive burns, comparing this to the general population, and identify injury and demographic-related factors predisposing individuals to psychosocial compromise.MethodsRE-ENERGIZE was an international, double-blinded, randomized-controlled trial that enrolled 1200 patients with partial- or full-thickness burns that required surgical treatment. For the post hoc analysis, we excluded participants who did not complete the Short Form Health Survey (SF-36) questionnaire. Normative data were taken from the 2021 National Health Interview Survey dataset. Propensity score matching was performed using the nearest-neighbor 1-to-1 method, and the two cohorts were compared in terms of chronic pain, and symptoms of anxiety and depression. A multivariable analysis was performed on the burns cohort to identify factors predicting post-discharge pain and symptoms of anxiety and depression.ResultsA total of 600 burn patients and 26,666 general population adults were included in this study. Following propensity score matching, both groups comprised 478 participants each, who were predominately male, white, overweight and between 20 and 60 years old. Compared to the general population, burn patients were significantly more likely to report the presence of moderate and a lot of pain (p = 0.002). Symptoms of anxiety were significantly higher in the burn population in two of four levels (most of the time; some of the time; p < 0.0001 for both). Responders in the burn population were significantly less likely to report the absence of depressive symptoms (p < 0.0001). Burn patients were also significantly more likely to report that their mental health affects their social life. TBSA, history of depression, and female sex were identified as independently associated factors for pain, anxiety, and depressive symptoms. The presence of chronic pain and anxiety symptoms independently predicted for symptoms of depression.ConclusionsAnalyzing the largest multicenter cohort of patients with extensive burns, we find that burn injury is associated with chronic pain, and symptoms of anxiety and depression. In addition, TBSA-burned and history of depression directly correlate with the prevalence of chronic pain, and symptoms of anxiety and depression. Finally, pain, and symptoms of anxiety and depression are interrelated and may have interactive effects on the process of recovery following burn injury. Burn patients would, therefore, benefit from a multidisciplinary team approach with early mobilization of pain and mental health experts, in order to promptly prevent the development of psychosocial challenges and their consequences.

Self-Reported Visual Disability and Unemployment: Findings from the National Health Interview Survey

ABSTRACT Purpose To investigate the association between visual impairment and employment status due to disability, utilizing data from the 2022 National Health Interview Survey (NHIS). Methods Adults 18 years of age and older were extracted from the 2022 NHIS dataset. A multivariable logistic regression model was created to evaluate the odds of unemployment (“laid off” and “looking for work”). Persons over the age of 65, as well as persons retired, going to school, self-employed, seasonal, or contract workers were excluded. Independent variables for the model included gender, race, Hispanic ethnicity, urban residency, level of education, citizenship, and self-reported vision. The latter variable was categorized as seeing with “some” difficulty, with “severe” difficulty, “can’t see at all,” and “a lot of difficulty.” Outcomes were reported as odds ratios (OR) with 95% confidence intervals (CI). Results Associations with unemployment included education less than high school (OR 6.05, 95% CI: 3.98-9.18) and high school (OR 3.80, 95% CI 2.78-5.21); severe vision difficulty (OR 3.68 95% CI 1.73-7.86); Asian race (OR 2.53, 95% CI 1.64-3.89); and Black race (OR 1.78, 95% CI 1.31-2.41). The odds of unemployment were marginally elevated for those living in large metropolitan areas, while being born in the United States had a modest protective effect (OR 0.53, 95% CI 0.42-0.66). Conclusion The degree of visual impairment in this post-COVID-19 pandemic survey substantially affects employment, which is consistent with historical studies. Education among those with impaired vision is an important and modifiable variable that can positively influence the chances of employment.

An Intersectional Approach to Examining Breast Cancer Screening among Subpopulations of Black Women in the United States.

This study examines breast cancer screening behavior among subpopulations of Black women in the United States. Binary logistic regression was used to analyze breast cancer screening among a nationally-representative sample (n = 9,783) of Black women-US-born, non-US-born Caribbean, and non-US-born African-from the 2011-2017 National Health Interview Survey dataset. Non-US-born African Black women were less likely to have breast cancer screening, compared to US-born Black women. Among non-US-born Black women, non-US-born Caribbean Black women were more likely to have had breast cancer screening. Differential healthcare access associated with nativity differences among Black women can be informing their breast cancer screening behaviors. Efforts to improve breast cancer outcomes among Black women can benefit from interventions that account for differential access to healthcare and breast cancer screening behaviors among subgroups of Black women.

0675 Levels of Depression Differentially Affect Sleep in People Who Have Had Cancer: Findings from the National Health Interview Survey

Abstract Introduction Cancer survivors experience an increased stress burden. Twenty-five percent (25%) of cancer survivors experience persistent depressive and anxiety symptoms and 40% are afflicted with chronic sleep problems. Analysis of this relationship between survivors’ mental health and sleep may elucidate components of stress burden in a particularly vulnerable population. This study examined the relationship between anxious and depressive symptoms and frequency predicting sleep patterns, comparing individuals with a cancer history versus those without. Methods Data emanated from the 2020 National Health Interview Survey dataset (n=31,568). Six percent (n=1936) of respondents reported a cancer history. The primary outcome was sleep duration, based on the average hours of sleep per night an individual reported over the past month, which was coded into “healthy” (7-8 hrs.) vs “unhealthy” (&amp;lt; 7 hrs. or &amp;gt; 9 hrs.) sleep. Level of anxiety and depression as well as frequency of reported symptoms were included in the models as predictors. Binary logistic regression models were performed to determine the discrete impact of depression and anxiety on sleep duration among individuals with and without a cancer history. Adjusted models included the demographic covariates of age, sex, education, household income, and race. Results In adjusted models, frequency of anxious feelings (OR = 1.19, p&amp;lt;.01,), frequency of depressive feelings (OR =1.29, p&amp;lt;.01,), level of anxious feelings (OR = 1.38, p&amp;lt;.01,), and level of depressive feelings (OR=1.15, p&amp;lt;.01) significantly predicted unhealthy sleep in the full sample. However, among individuals with a cancer history, frequency of anxious feelings (OR =1.16, p&amp;lt;.01,), level of anxious feelings (OR = 1.28, p&amp;lt;.01,) and frequency of depressive feelings (OR = 1.23, p&amp;lt;.01,) significantly predicted unhealthy sleep duration, but level of depressive feelings did not (OR = 1.08, p=.13,). Conclusion Mental health and sleep are closely and bidirectionally connected in the general population, but among individuals with a history of cancer the link between level of depression and healthy sleep were not significant. Further research is needed to understand the complex relationship between mental health and sleep among people with a cancer history. Support (if any) K01HL135452, K07AG052685, R01AG072644, R01HL152453, R01MD007716, R01HL142066, R01AG067523, R01AG056031, and R01AG075007.

Herbal Supplement Use for Evidence-Based Indications in US Adults: An Analysis of National Survey Data.

Objective: Understanding the changes in consumer use of herbal products and what has influenced these changes is key in the promotion of evidence informed use. The last analysis of evidence informed herbal supplement use involved the 2002 National Health Interview Survey (NHIS) analysis. This study reproduces and expands upon that earlier analysis, with the most recent NHIS dataset to report herb use patterns. It also explores the guiding resources consulted by consumers in their decision to use. Methods: Secondary analysis of cross-sectional data from the NHIS identified the 10 herbal supplements with the most reported use in 2012. The reasons reported by the NHIS for taking herbal supplements were compared with the 2019 Natural Medicines Comprehensive Database (NMCD) to determine whether reasons cited in consumption were supported by evidence. Logistic regression models were fit according to NHIS sampling weights to examine the relationship between evidence-based use and user characteristics, guiding resources, and health care professional engagement surrounding use. Results: Of the 181 reported uses of herb supplements for a specific health condition, 62.5% were for reasons supported by evidence-based indications (EBIs). The odds of herb use consistent with evidence significantly increased for those reporting higher education status (odds ratio [OR] = 3.01, 95% confidence interval [CI] [1.70-5.34]). Herbal supplement use consistent with EBIs was more likely among those who disclosed their herb use to a health care professional (OR = 1.77, 95% CI [1.26-2.49]). Evidence-based herb use was also less frequently informed by Media sources (OR = 0.43, 95% CI [0.28-0.66]) compared with non-EBI use. Conclusion: Approximately 62% of the reasons cited for taking the most consumed herbs in 2012 were in alignment with 2019 EBIs. This increase may be due to improved awareness of health care professionals and/or an increase of evidence for traditional uses of herbal products. Future research should explore the role of each of these stakeholders in improving evidence-based herb use in the general population.

The Impact of Social Determinants of Health on Vision Loss From Cataracts and Cataract Surgery Utilization in the United States—A National Health Interview Survey Analysis

To investigate the association of social determinants of health (SDOH) factors and cataract-related outcomes disparities. Cross-sectional, with a nationally representative sample. We used publicly available data from the 2008, 2016, and 2017 National Health Interview Survey datasets. Outcome measures included self-reported prevalence for ever been diagnosed with cataract, vision loss secondary to cataracts, and likelihood of undergoing cataract surgery. Survey-weighted, multivariable logistic regression models, adjusted for age, race/ethnicity, and other relevant covariates, were used to examine the association between SDOH factors and cataract-related outcomes. 81,551 participants were included, who were predominantly between 18 to 44 years (49.6%), female (51.7%), and White (74.8%). Multivariable regression models with age as a covariate showed that individuals who were not working were more likely to report having cataracts compared to those who were working (P < .001). Those who needed but could not afford medical care in the past year were more likely to report vision loss secondary to cataracts compared to their counterparts (P < .001). Uninsured participants were less likely to report undergoing cataract surgery compared to those with private insurance (P = .03). Individuals with higher income (poverty-income ratio [PIR] 1.00-2.99 vs <1.00) were more likely to report undergoing cataract surgery (P = .04). Several SDOH factors were associated with disparities in rates of cataract-related outcomes. These findings highlight the importance of ophthalmologists screening for social risks in patients with cataract, as these social factors are important barriers for access to care.

Factors Associated with Annual Vision Screening in Diabetic Adults: Analysis of the 2019 National Health Interview Survey.

To determine the association(s) between receiving an annual eye exam and various economic, social, and geographic factors assessed in the 2019 National Health Interview Survey (NHIS) among adults with diabetes. Data from adults 18 years of age and older relevant to self-reported non-gestational diabetes diagnosis and eye exam within the last 12 months were extracted from the 2019 NHIS dataset. A multivariate logistic regression model was used to determine associations between receiving an eye exam in the preceding 12 months and various economic, insurance-related, geographic, and social factors. Outcomes were reported as odds ratios (OR) with 95% confidence intervals (CI). Among diabetic adults in the US, receiving an eye exam within the last 12 months was significantly associated with female sex (OR 1.29; 95% CI 1.05-1.58), residence in the Midwestern United States (OR 1.39; 95% CI 1.01-1.92), use of Veteran's Health Administration healthcare (OR 2.15; 95% CI 1.34-3.44), having a usual place to go for healthcare (OR 3.89; 95% CI 2.16-7.01), and the use of Private, Medicare Advantage, or other insurance (OR 3.66; 95% CI 2.42-5.53), use of Medicare only excluding Medicare Advantage (OR 3.18; 95% CI 1.95-5.30), dual eligibility for Medicare and Medicaid (OR 3.88; 95% CI 2.21-6.79), and use of Medicaid and other public health insurance (OR 3.04; 95% CI 1.89-4.88) compared to those without insurance. An educational attainment of less than high school (OR 0.66; 95% CI 0.48-0.92), and an educational attainment of high school or GED without any college (OR 0.62; 95% CI 0.47-0.81) reduced the odds of having an annual eye exam. Economic, social, and geographic factors are associated with diabetic adults receiving an annual eye exam.

Gender, socioeconomic status and emergency department visits among cancer survivors in the USA: a population-based study.

Aim: To assess patterns of emergency department visits and subsequent hospitalization in relation to gender and socioeconomic status among a cohort ofcancer survivors in the USA. Materials & methods: National Health Interview Surveydatasets (2011-2017) were reviewed and participants with a history of cancer and complete information about emergency department visits in the past 12months were included. Multivariable logistic regression analyses were used to assess factors associated with emergency department visits and subsequent hospitalization after the most recent emergency department visit. Results: A total of 22,240 cancer survivors were included in the current analysis; of which 16,133 participants (72.5%) who have not visited an emergency department in the past 12months and 6107 participants (27.5%) who have visited an emergency department in the past 12months. Multivariable logistic regression analysis suggested the following factors are associated with emergency department visits; younger age (odds ratio [OR] with increasing age: 0.98; 95% CI: 0.98-0.99), female gender (OR: 1.07; 95% CI: 1.00-1.15), African American race (OR: 1.26; 95% CI: 1.13-1.40), unmarried status (OR for married vs unmarried: 0.79; 95% CI: 0.74-0.84), lower yearly earnings (OR: 1.36; 95% CI: 1.20-1.54), poor health status (OR: 7.02; 95% CI: 6.02-8.18) and incomplete health insurance coverage (OR for complete coverage vs incomplete coverage: 0.66; 95% CI: 0.54-0.80). On the other hand, the following factors were associated with subsequent hospitalization: older age (OR: 1.004; 95% CI: 1.000-1.008), male gender (OR for female vs male: 0.86; 95% CI: 0.78-0.94), unmarried status (OR for married vs unmarried status: 0.80; 95% CI: 0.73-0.88), not working (OR: 1.44; 95% CI: 1.23-1.68), lower yearly earnings (OR: 1.31; 95% CI: 1.07-1.60), poor health status (OR: 8.43; 95% CI: 6.76-10.51) and lack of health insurance coverage (OR for complete coverage vs incomplete coverage: 0.71; 95% CI: 0.55-0.93). Conclusion: Female cancer survivors were more likely to visit the emergency department, whereas they were less likely to be subsequently hospitalized. Cancer survivors with lower socioeconomic status were more likely to visit emergency departments and to be subsequently hospitalized.

Patterns and association of vaccination among adults with a history of cancer in the USA: a population-based study.

Aim: To assess the associationof vaccination status among adults with history of cancer in a population-based cohort in the USA. Materials & methods: National Health Interview Survey datasets (2008-2018) have been accessed and information about the patterns and associations of the following vaccinations were collected (influenza vaccination, pneumococcal vaccination, hepatitis B vaccination, hepatitis A vaccinationand shingles vaccination). Association of different sociodemographic variables with each of the above types of vaccination was studied through multivariable logistic regression analysis. Results: Private health insurance (vsno private insurance) was associated with higher percentages of recommended vaccination (influenza vaccination: 65vs 59.7%; pneumococcal vaccination: 74.9vs 68.8%; hepatitis B vaccination: 22.9vs 19.3%; hepatitis A vaccination: 10.1vs 8.6%; shingles vaccination: 33.8vs 26.7%; p < 0.001 for all comparisons). Within multivariable logistic regression analyses, African American race, lower education and lower income were associated with less probability of adherence to recommended vaccination (for influenza vaccination; odds ratio (OR) for black race vs white race: 0.785; 95% CI: 0.717-0.859; OR for ≤high school vs >high school education: 0.763; 95% CI: 0.723-0.805; OR for income ≤US$45,000vs >US$45,000: 0.701; 95% CI: 0.643-0.764). Conclusion: There is evidence of socio-economic disparities in adherence to recommended vaccination among this cohort ofcancer survivors in the USA. More efforts need to be done to ensure that recommended vaccination is being delivered to all cancer survivors in need (including enhancing coverage and awareness to under-represented groups of the society).

Patient-related barriers to some virtual healthcare services among cancer patients in the USA: a population-based study.

Objective: To assess the patient-related barriers to access of some virtual healthcare tools among cancer patients in the USAin a population-based cohort. Materials & methods: National Health Interview Survey datasets (2011-2018) were reviewed and adult participants (≥18years old) with a history of cancer diagnosis and complete information about virtual healthcare utilization (defined by [a]filling a prescription on the internet in the past 12months and/or [b]communicating with a healthcare provider through email in the past 12months) were included. Information about video-conferenced phone calls and telephone calls are not available in the National Health Interview Survey datasets; and thus, they were not examined in this study. Multivariable logistic regression analysis was used to evaluate factors associated with the utilization of virtual care tools. Results: A total of 25,121 participants were included in the current analysis; including 4499 participants (17.9%) who utilized virtual care in the past 12months and 20,622 participants (82.1%) who did not utilize virtual care in the past 12months. The following factors were associated with less utilization of virtual healthcare tools in multivariable logistic regression: older age (continuousodds ratio [OR] with increasing age: 0.987; 95% CI: 0.984-0.990), African-American race (OR for African American vs white race: 0.608; 95% CI: 0.517-0.715), unmarried status (OR for unmarried compared with married status: 0.689; 95% CI: 0.642-0.739), lower level of education (OR for education ≤high school vs >high school: 0.284; 95% CI: 0.259-0.311), weaker English proficiency (OR for no proficiency vs very good proficiency: 0.224; 95% CI: 0.091-0.552) and lower yearly earnings (OR for earnings <$45,000vs earnings >$45,000: 0.582; 95% CI: 0.523-0.647). Conclusion: Older patients, those with African-American race, lower education, lower earnings and weak English proficiency are less likely to access the above studied virtual healthcare tools. Further efforts are needed to tackle disparities in telemedicine access.

Associations of Social Determinants of Health and Self-Reported Visual Difficulty: Analysis of the 2016 National Health Interview Survey

ABSTRACTPurpose: To determine the association of selected social determinants of health (SDH) assessed by the National Health Interview Survey (NHIS) among adults with visual difficulty.Methods: Data from adults 18 years of age and older relevant to self-reported visual difficulty were extracted from the 2016 NHIS dataset. A multivariate logistic regression model was used to determine associations between self-reported visual difficulty and key social determinants of health identified by the Kaiser Family Foundation and American College of Physicians. Outcomes were reported as odds ratios (OR) with 95% confidence intervals (CI).Results: Self-reported visual difficulty was significantly associated with lower educational attainment (OR 1.54; 95% CI, 1.30–1.81), having healthcare coverage through Medicaid (OR 1.44; 95% CI, 1.23–1.67), food insecurity (OR 1.75; 95% CI, 1.54–1.99), problems with paying medical bills (OR 1.60; 95% CI, 1.40–1.83), trouble finding a doctor (OR 1.49; 95% CI, 1.19–1.86), cost-related medication underuse (OR 1.72; 95% CI, 1.54–1.93), and identification as a non-heterosexual male (OR 1.82; 95% CI, 1.21–2.73). Those who were employed were at lower risk of visual difficulty compared to those who were looking for work or not working (OR 0.79; 95% CI, 0.71–0.89).Conclusion: A subset of SDH as evaluated by the NHIS are positively associated with self-reported visual difficulty. If validated, these results could inform future public health interventions that may reduce the incidence and burden of visual difficulty.

Household Food Insecurity among African Immigrants of the United States: Evidence from the National Health Interview Survey

ABSTRACT The annual number of immigrants from sub-Saharan Africa to the United States (US) has roughly doubled every decade between 1980 and 2010. By 2015 the current and growing population of African Immigrants was estimated at 1.7 million, accounting for 4% of the 43.3 million immigrants in the US. The objective of this study is to investigate factors that influence the food security status of African Immigrant households in the US. Data from the Integrated Public Use Microdata Series (IPUMS) Health Survey, a harmonized data of the 2015 National Health Interview Survey (NHIS) was used. Food security (dependent variable) was measured using the USDA Household Food Security Survey Module (HFSSM) included in the NHIS data set. Independent variables included variables on immigration, economic and household characteristics. Multivariate logistic regression testing relationship of food security with the independent variables was done.

Moderating effects of sleep duration on diabetes risk among cancer survivors: analysis of the National Health Interview Survey in the USA

BackgroundGrowing evidence suggests that cancer and diabetes may share common risk factors such as age, race/ethnicity, obesity, insulin resistance, sedentary lifestyle, smoking, and alcohol consumption. However, little is known about how habitual sleep duration (a known cardiometabolic risk factor) may affect the relationship between cancer and diabetes. The aim of this study was to investigate whether sleep duration moderated the relationship between history of cancer and diabetes.MethodsData were extracted from the National Health Interview Survey dataset from 2004 to 2013 containing demographics, chronic diseases, and sleep duration (N=236,406). Data were analyzed to assess the moderating effect of short and long sleep durations on cancer and diabetes mellitus.ResultsOur findings indicate that short sleep (odds ratio [OR] =1.07, 95% CI =1.03–1.11, P<0.001) and long sleep (OR =1.32, 95% CI =1.26–1.39, P<0.001) were associated with diabetes mellitus in fully adjusted models. However, only long sleep duration significantly moderated the relationship between cancer and diabetes (OR =0.88, 95% CI =0.78–0.98, P<0.05).ConclusionOur findings indicate that for cancer survivors, short sleep was associated with higher self-reported diabetes and long sleep duration may act as a buffer against diabetes mellitus, as the likelihood of self-reported diabetes was lower among cancer survivors who reported long sleep duration.ImpactFindings from the current study have clinical and public health implications. Clinically, comprehensive sleep assessments and sleep interventions to improve sleep are needed for cancer survivors who have comorbid diabetes. Our findings can also spur public health reform to make sleep an important component of standard cancer survivorship care, as it reduces other chronic disease like diabetes.

Factors associated with insomnia and complementary medicine use in children: results of a national survey

ObjectivesSleep difficulties are a serious health problem in children, and interest in using complementary and alternative medicine (CAM) therapies to treat sleep is growing. In this study, we aimed to identify: the prevalence of sleep difficulties in children, and the prevalence and patterns of CAM use among children with trouble sleeping. MethodsWe used the 2012 National Health Interview Survey (NHIS) dataset to estimate the prevalence of sleep difficulties and CAM use in children ages 6–17 years. Prevalence estimates were weighted to reflect the survey's sampling design. We used logistic regression to explore associations between sleep difficulties, psychosocial factors, comorbidities and CAM use. Results6.4% of children in the 2012 NHIS dataset reported regular difficulty sleeping in the last year, corresponding to an estimated 1.5 million children in the US. Older age, poorer health status, more missed school days, and multiple comorbidities were all associated with sleep difficulties (p ≤ 0.001). Among children with sleep difficulties, 29% used at least one CAM therapy. Of the CAM therapies surveyed, non-vitamin, non-mineral supplements were the most commonly used (14.6%), followed by manipulation therapies (9.2%) and mind-body techniques (8.8%). Parental education and CAM use were most strongly associated with child CAM use (p ≤ 0.001). ConclusionsCAM therapies, particularly non-vitamin, non-mineral supplements, are commonly used among children with sleeping problems. More research is needed to characterize the safety and efficacy of CAM therapies for sleep in this population.

Association between obesity and risk of chronic kidney disease: A nationwide Cohort study in Taiwan

Background and aimsIncreased body fat relates to enhanced inflammatory cytokine production, which, in turn, activates the renin-angiotensin-aldosterone system and increases the risk of chronic kidney disease (CKD). Herein, we aimed to examine the association between obesity and the risk of CKD in a population-representative cohort in Taiwan. Methods and resultsA multistage systematic sampling process was applied in the National Health Interview Survey (NHIS) 2000, 2005, and 2009. Participants were interviewed by a standardized face-to-face questionnaire to obtain information on their demographics, socioeconomic status, lifestyle factors, and body mass index (BMI). The BMI values were classified as follows: underweight (<18.5 kg/m2), normal (18.5–23.9 kg/m2), overweight (24–26.9 kg/m2), and obesity (≥27 kg/m2). The NHIS dataset was linked to National Health Insurance claims data to identify the incidence of CKD. Univariate and multivariate Cox proportional hazard models with competing risks were used to investigate the association between BMI and CKD incidence. We analyzed 45,012 subjects (mean age, 42.03 years; 50.09% males). During 374,254 person-years of follow-up, a total of 1913 new-onset CKD cases were identified. Kaplan–Meier curves comparing the four BMI groups revealed a significant difference (p < 0.01, log-rank test). After controlling for confounding factors, the relative risk of incident CKD was significantly higher in the obese group compared to the normal-weight group (adjusted hazard ratio = 1.32; 95% confidence interval: 1.17–1.49), with a significant linear trend (p < 0.01). ConclusionObesity was suggested as an independent risk factor for CKD. Further studies focusing on the effect of losing weight on CKD prevention are warranted.

A retrospective cohort study on the risk of stroke in relation to a priori health knowledge level among people with type 2 diabetes mellitus in Taiwan

BackgroundIntervention of diabetes care education with regular laboratory check-up in outpatient visits showed long-term benefits to reduce the risk of macrovascular complications among people with type 2 diabetes. However, research on the level of a priori health knowledge to the prevention of diabetic complications in community settings has been scarce. We therefore aimed to investigate the association of health knowledge and stroke incidence in patients with type 2 diabetes in Taiwan.MethodsA nationally representative sample of general Taiwanese population was selected using a multistage systematic sampling process from Taiwan National Health Interview Survey (NHIS) in 2005. Subjects were interviewed by a standardized face-to-face questionnaire in the survey, obtaining information of demographics, socioeconomic status, family medical history, obesity, health behaviors, and 15-item health knowledge assessment. The NHIS dataset was linked to Taiwan National Health Insurance claims data to retrieve the diagnosis of type 2 diabetes in NHIS participants at baseline and identify follow-up incidence of stroke from 2005 to 2013. Univariate and multivariate Cox regressions were used to estimate the effect of baseline health knowledge level to the risk of stroke incidence among this group of people with type 2 diabetes.ResultsA total of 597 diabetic patients with a mean age of 51.28 years old and nearly half of males were analyzed. During the 9-year follow-up period, 65 new stroke cases were identified among them. Kaplan–Meier curves comparing the three groups of low/moderate/high knowledge levels revealed a statistical significance (p-value of log-rank test <0.01). After controlling for potential confounders, comparing to the group of low health knowledge level, the relative risk of stroke was significantly lower for those with moderate (adjusted hazard ratio [AHR] = 0.63; 95% CI, 0.33–1.19; p-value = 0.15) and high level of health knowledge (AHR = 0.43; 95% CI, 0.22–0.86; p-value = 0.02), with a significant linear trend (p-value = 0.02).ConclusionsAn exposure-response gradient of moderate to high health knowledge levels to the prevention of stroke incidence among people with type 2 diabetes in community was found with 9 years of follow-up in Taiwan. Development and delivery of health education on stroke prevention to people with type 2 diabetes are warranted.

Factors associated with complementary medicine use in pediatric musculoskeletal conditions: Results from a national survey

ObjectivesComplementary and alternative medicine (CAM) use is common in children, but its use has only been investigated in children with musculoskeletal conditions (MSK) to a limited extent. We aimed to characterize factors associated with CAM use in children with MSK conditions. MethodsWithin the 2012 National Health Interview Survey dataset (including its child CAM supplement), we examined factors associated with CAM use in children with MSK conditions and performed an analysis examining the perceived usefulness of CAM therapies for MSK conditions. ResultsOverall, there were 10,218 children in the dataset. 28.0% of children with MSK conditions used CAM, compared to 8.8% of children without MSK conditions. Gender (p=0.003), region (p=0.001), race (p=0.001), parental CAM use (p<0.001), education (<0.001), and having anxiety, stress or depression (p=0.030) were correlated with CAM use. Among 90 children who reported on CAM use, 89.7% said that CAM helped some or a great deal for their MSK condition. ConclusionsSeveral factors, particularly parental education and parental CAM use, were associated with CAM use, and self-reported improvement rates were high. Interventional trials are needed to determine the efficacy of specific CAM therapies for treating different MSK conditions in children.

Association of Diabetes and Colorectal Cancer Screening

Introduction: Colorectal cancer (CRC) is the third leading cause of mortality due to cancer among men and women. Among other known risk factors such as diet and exercise, Type 2 diabetes is considered as an independent risk factor for CRC. Despite this, there are no specific guidelines for diabetics with regard to CRC screening. Our study aimed to determine the association between diabetes and colorectal cancer screening [CRCS] in a nationally representative dataset among adults over the age of 40 years after adjusting for (i) racial/ethnic differences (ii) weight status measured by Body Mass Index [BMI] iii) income to poverty ratio (iv) smoking status (v) age and (vi) family history of colon cancer. We hypothesized the association of these factors with CRC screening based on current literature. Our study hypothesis is that CRC Screening rates are higher in adults over the age of 40 years with a diagnosis of diabetes than adults over 40 years of age without diabetes. Additionally, the association between diabetes and CRCS in adults over the age of 40 years is attenuated after adjusting for race/ethnicity, BMI, income to poverty ratio, smoking, age and family history of colon cancer. Methods: This study analyzed data from the 2010 National Health Interview Survey(NHIS), a nationally representative, cross-sectional, household survey of the civilian noninstitutionalized population of the United States. We used the sample adult, family, person, family, household and adult cancer files from 2010 NHIS data set. NHIS respondents in this study were individuals aged 40 to 80 years old. We excluded individuals who had missing data on diabetes and other variables like race/ethnicity, smoking status, poverty income ratio, BMI and family history of colon cancer, which resulted in a final sample of n=13691. Results: The odds of getting screened for CRC (after adjusting for covariates in our study) among those who have diabetes over age 40yrs is 1.16 times more than those who do not have diabetes. From our crude model, we found that the odds of getting screened for colorectal cancer among those who have diabetes over age 40yrs is 1.53 times (Confidence interval 1.39 - 1.68) more than those who do not have diabetes. Conclusion: Conclusion:CRCS among diabetics over age 40yrs is affected by age, gender, race/ethnicity, ratio of family income to the poverty threshold, smoking, BMI and family history of colon cancer. There is a need to develop guidelines to encourage diabetics to get screened for CRC.Table 1: Adjusted model (Age, Gender and Race/ethnicity, Ratio of family income to the poverty threshold, smoking, BMI, family history of colon cancer)

Methodologic Artifacts in Adult Sun-Protection Trends

Skin cancer is the most common of all cancers and a public health concern of increasing magnitude in the U.S. A mid-year review of Healthy People 2010 found that the percentage of adults engaging in sun-safe practices increased from 59% in 2000 to 71% in 2005. This paper examines whether this increase in sun-safe practices in adults is an artifact caused by the change from 2000 to 2005 in the operational definition of "sun-safe practices" in the National Health Interview Survey (NHIS). This study analyzed the 2000 and 2005 NHIS data sets in 2009 to examine changes in sun-safe practice prevalence estimates and to estimate the relative odds of practicing sun-safe behaviors associated with gender, age, race/ethnicity, education, and geographic region. Contrary to the Healthy People 2010 mid-year review, it was found that engaging in sun-safe practices by adults decreased from 59% (2000) to 55% (2005). A question order effect and use of images for use of sun-safe hats likely caused an artificial change in "cover-up" behavior estimates from 31% (2000) to 18% (2005) and wide-brim hat usage from 27% (2000) to 12% (2005). When eliminating data from these two questions added in 2005, the relative odds of practicing sun-safe behaviors was significantly lower for men in both 2000 and 2005 but were not different for other demographic characteristics. The current analyses suggest that the increase in sun-safe behaviors in adults and a notable decrease in "hat use" may be due to methodologic artifacts. When operational definitions change, caution should be used in interpreting estimates over time.