National Trends Survey Research Articles

Telehealth utilization and adherence to cervical cancer screening among women in the United States.

383 Background: Cervical cancer (CC) screening has dramatically reduced incidence and mortality from cervical cancer over the last 5 decades. However, the prevalence of overdue screenings is increasing in the United States (US). Telehealth helps facilitate access to health care and services, but its impact on CC screening adherence is unknown. Methods: Data for this cross-sectional study were obtained from the 2022 Health Information and National Trends Survey, including female respondents aged 21-65 years. Women with a history of CC and missing data were excluded. Telehealth utilization (yes/no) was defined as having received care from a doctor or health professional using telehealth (i.e., phone and/or video) in the past 12 months. The outcome was adherence to CC screening (yes/no), measured as having a Pap test within the last 3 years. Weighted percentages and 95% CIs were compared using Chi-squared tests. Multivariable logistic regression models were fit to assess the association between telehealth utilization and adherence to CC screening, overall and by race/ethnicity. All analyses accounted for survey weights. Results: The study sample included 2,029 unweighted respondents, representing a weighted sample of 81,500,000 US women eligible for CC screening. Overall, 46.2% had a telehealth visit in the past 12 months. The mean age was 44 years; 57% were Non-Hispanic White, 19% were Hispanic, 13% were Non-Hispanic Black, and 11% were Asian or Pacific Islander. Telehealth users were more likely to be college graduates (43% vs. 35%, p=.047), insured (93% vs. 87%, p<.001), and to have had at least one comorbidity condition (69% vs. 48%, p<.001). After controlling for covariates, telehealth users had higher odds of adherence to CC screening than non-users (adjusted odds ratio [aOR] 1.63, 95% CI: 1.14-2.33). When stratified by race/ethnicity, among Hispanic women, those who utilized telehealth had greater odds of CC screening adherence compared to those who did not (aOR 2.83, 95% CI: 1.27-6.28). There were no significant associations between telehealth use and adherence to CC screening among other racial groups. Conclusions: Telehealth use was prevalent among US women and was associated with an increased likelihood of CC screening adherence, particularly among Hispanic women. These findings suggest that telehealth could be a significant tool in improving dwindling CC screening rates. Future research is also needed to explore the barriers to telehealth access to optimize its benefits among women eligible for CC screening.

Sociodemographic and Clinical Characteristics Associated with Genetic Testing among Cancer Survivors: Evidence from Three Cancer Registries.

Genetic tests, including germline and tumor (somatic) testing, can optimize the clinical care and outcomes for cancer patients and their family members. However, evidence on cancer patients' use of genetic testing and discussions about it with healthcare providers is limited. Study participants included cancer survivors aged 18 or older, drawn from the 2021 Health Information and National Trends Survey (HINTS)-Surveillance, Epidemiology, and End Results (SEER) linked database, which comprises three US cancer registries: Iowa, New Mexico, and the Greater Bay Area. Sociodemographic factors (e.g., age, sex, income, education) at the time of the survey and clinical characteristics (e.g., cancer site, stage) at the time of diagnosis were compared based on self-reported genetic testing status and provider discussions, using survey design-adjusted analysis. The weighted study sample comprised 415,978 cancer survivors with a mean age of 70.5 years at the time of the survey. Overall, 17.0% reported having germline testing, 8.5% having tumor testing, and 8.6% discussing tumor testing with their healthcare providers. Higher proportions of germline genetic testing were observed among survivors under age 65 at the time of the survey, females, holding college degrees, and with private insurance coverage compared to their respective counterparts - males, aged 65 or above when surveyed, with lower educational attainment, and with public insurance or uninsured. The proportion of those who reported tumor testing was greater for those diagnosed in recent years (2015-2017 vs. before 2002). Regarding clinical characteristics, survivors with ovarian and breast cancers had a 7.0-36.4% higher prevalence of both testing compared to those with other cancer types lacking germline indication. More cancer survivors diagnosed at distant stages (vs. regional) or between 2015 and 2017 (vs. 2003-2010) reported having provider discussions about tumor testing. Findings showed that the highest reports of germline testing were among young female cancer survivors and those with higher education and private insurance. Survivors diagnosed in recent years or with advanced-stage disease were more likely to report discussing tumor testing with providers. Further research is warranted to better understand the barriers and educational needs of cancer patients, caregivers, and providers to optimize genetic testing strategies.

Improvement of the Ocular Prognosis of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A National Survey in Japan

To investigate the incidence and prognostic factors of ocular sequelae in Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) cases arising between 2016 and 2018 in Japan, and compare the findings with those presented in the previous 2005-2007 survey. Retrospective, national trend survey. Dermatologic case report forms (CRFs) (d-CRFs) were sent to 257 institutions that treated at least 1 SJS/TEN case, and 508 CRFs were collected from 160 institutions. Ophthalmologic CRFs (o-CRFs) regarding patient demographic data, onset date, ocular findings (first appearance, day of worst severity, and final follow-up), topical treatment (betamethasone), outcome (survival or death), and ocular sequelae (visual disturbance, eye dryness) were sent to the ophthalmologists in those 160 institutions. The results of this survey were then compared with that of the previous 2005-2007 survey. A total of 240 cases (SJS/TEN: 132/108) were included. The incidence of ocular sequelae incidence was 14.0%, a significant decrease from the 39.2% in the previous survey (SJS/TEN: 87/48). In 197 (82.1%) of the cases, systemic treatment was initiated within 3 days after admission, an increase compared to the previous survey (ie, treatment initiated in 82 [60.7%] of 135 cases). Of the 85 cases with an Acute Ocular Severity Score of 2 and 3, 62 (72.9%) received corticosteroid pulse therapy and 73 (85.9%) received 0.1% betamethasone therapy; an increase compared to the 60.0% and 70.8%, respectively, in the previous survey. Ocular-sequelae-associated risk factors included Acute Ocular Severity Score (P < .001) and specific year in the survey (P < .001). The ophthalmologic prognosis of SJS/TEN has dramatically improved via early diagnosis, rapid assessment of acute ocular severity, and early treatment.

Poster 19 - A national survey of trends and attitudes towards adolescent/transitional urological care amongst incumbent members of the Irish Society of Urology

Poster 19 - A national survey of trends and attitudes towards adolescent/transitional urological care amongst incumbent members of the Irish Society of Urology

Awareness of symptoms, risk factors, and barriers to seeking help related to breast cancer among university students in Mexico City.

e18652 Background: In Mexico, about 15% of young women (age ≤ 40 years) have breast cancer (BC). However, only 40% of women in this age group know that they should practice self-examination, and only 30% know the proper technique. Additionally, studies carried out in this group show reasons for delaying diagnosis like emotional barriers when a sign is identified, and lack of knowledge of risk factors. The purpose of the present study is to identify knowledge about self-examination techniques, lifestyle, and risk factors that influence the development of BC in university students. Methods: In this exploratory study, we used a 10-section and 55-question questionnaire based on validated international tools such as the Cancer Awareness Measure (CAM) questionnaire (CAM), the National Survey of Trends in Health Information, and the Mediterranean Diet Score (MDS), as a healthy eating pattern. Results: A sample of 53 health sciences school students was analyzed, 93% were women, and the average age was 21 years old. 83% of the students did not feel capable of recognizing signs of BC. Regarding risk factors knowledge, 78.9% recognized using hormone replacement for more than 5 years, 32.7% early menarche age, 98.1% having a closer relative with BC, 63.4% drinking more than 1 unit of alcohol by day, 65.4% being overweight; as risk factors for BC. Interestingly, 32.7% consider being sedentary as a risk factor, however, 43.8% disagree or strongly disagree. The same happens with being overweight, the 34.6% did not recognize this condition as a BC risk. Higher meat consumption was present in 54.9% of the participants. Related to barriers to receiving medical attention if they had symptoms, 21.2% feel embarrassed and 30.8% are scared to see a doctor, 30.8% are too busy, 44.3% are worried about other things, 46.2% are worried about medical findings. Conclusions: Although there was a high recognition of non-modifiable risk, the students dismiss the lifestyle as a risk factor for BC and are not capable to recognize BC signs. It is important to develop interventions to increase knowledge of these risk factors and promote healthy lifestyles from a young age to improve BC prevention. The present study gave us information to design educational strategies, based on the identified needs, that can be implemented as a cancer prevention strategy in this age group. It is also necessary to implement BC cancer prevention education strategies in health sciences school students to improve their knowledge.

Abstract 4: Global Health Involvement of Plastic Surgeons While In Residency and In Practice: Is There a Correlation?

Background: It is generally assumed that global health involvement during training increases the likelihood that surgeons will participate in missions in practice. However, little data exists on the proportion of current practicing plastic surgeons who have participated in surgical missions prior to starting practice (before or during residency), and if this correlates with global health involvement while in practice. Methods: We conducted a survey of American Council of Academic Plastic Surgeons membership to ascertain the impact of mission experiences and volunteerism in training on future involvement as a practicing physician. Surgeons were surveyed regarding the number of surgical missions attended at different phases of their education prior to starting practice (i.e., prior to medical school, during medical school, and during residency), and while in practice. Respondents were stratified by the number of years they had been in practice. Statistical analysis was performed via Fisher’s exact test, chi-square test, and correlation matrix, where appropriate. Results: 60 surgeons returned the survey (response rate 16.5%). 18 (30%) had been practicing for less than 10 years, 16 (26.7%) for 10-20 years, and 26 (43.3%) for more than 20 years. 18.3% of surgeons participated in surgical missions prior to medical school, 1.7% during medical school, 48.3% in residency, and 80% in practice. No significant difference in the number of surgeons participating in international surgical mission trips was found between those who had attended their first mission prior to starting practice and while in practice, regardless of their educational status during the initial global health experience (p = 0.3275). Involvement in international surgical missions during residency specifically was weakly correlated with later involvement during practice (r = 0.003, p = 0.981). Conclusion: This study provides a national survey of trends in global health involvement by plastic surgeons in the United States. Although early involvement in surgical missions is weakly correlated with global health involvement later in life, overall participation in missions was high in the sample of academic plastic surgeons who completed this survey.

A National Survey of Trends in Health Insurance Coverage of Low-Income Adults Following Medicaid Expansion.

A National Survey of Trends in Health Insurance Coverage of Low-Income Adults Following Medicaid Expansion.

Rural-urban differences in financial burden among cancer survivors: an analysis of a nationally representative survey.

Rural cancer survivors may disproportionately experience financial problems due to their cancer because of greater travel costs, higher uninsured/underinsured rates, and other factors compared to their urban counterparts. Our objective was to examine rural-urban differences in reported financial problems due to cancer using a nationally representative survey. We used data from three iterations of the National Cancer Institute's Health Information and National Trends Survey (2012, 2014, and 2017) to identify participants who had a previous or current cancer diagnosis. Our outcome of interest was self-reported financial problems associated with cancer diagnosis and treatment. Rural-urban status was defined using 2003 Rural-Urban Continuum Codes. We calculated weighted percentages and Wald chi-square statistics to assess rural-urban differences in demographic and cancer characteristics. In multivariable logistic regression models, we examined the association between rural-urban status and other factors and financial problems, reporting the corresponding adjusted predicted probabilities. Our sample included 1359 cancer survivors. Rural cancer survivors were more likely to be married, retired, and live in the Midwest or South. Over half (50.5%) of rural cancer survivors reported financial problems due to cancer compared to 38.8% of urban survivors (p = 0.02). This difference was attenuated in multivariable models, 49.3 and 38.7% in rural and urban survivors, respectively (p = 0.06). A higher proportion of rural survivors reported financial problems associated with their cancer diagnosis and treatment compared to urban survivors. Future research should aim to elucidate these disparities and interventions should be tested to address the cancer-related financial problems experienced by rural survivors.

Sex differences in the use of healthcare services among US adults with and without a cancer diagnosis.

Cancer imposes higher burden on men. Sex differences in healthcare utilization may contribute to this problem. We compared healthcare utilization among adults with and without a history of cancer as measured by having at least one physician visit within the previous 12 months. We analyzed data from 7,229 responders (weighted population size=211,722,892) enrolled in the 2007 Health Information and National Trends Survey (HINTS), a nationally representative sample of non-institutionalized adults in the United States. We used survey weights in all analyses and variance estimation procedures to account for the complex survey design and used logistic regression models to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Study participants consisted of 2808 (48.6%) males and 4421 (51.4%) females. Overall, men were less likely to have seen a physician within the previous 12 months (OR=0.39; 95% CI: 0.31-0.48) regardless of their cancer status. Cancer survivors were more likely to visit a physician within the previous 12 months (OR=2.01; 95% CI: 1.28-3.19) regardless of sex. When stratified by personal history of cancer, men without a history of cancer were less likely to visit a physician (OR=0.38; 95% CI: 0.30-0.47) whereas men with a history of cancer were as likely to have seen a physician in the previous 12 months as women with similar cancer status (OR=1.24; 95% CI: 0.44-3.45). Men increase their healthcare utilization to that of women only after they receive diagnosis of cancer. Targeted interventions to promote utilization of preventive care services by men are needed to reduce the burden of chronic illnesses including cancer among men.

The Effect of Cancer Information Seeking on Perceptions of Cancer Risks, Fatalism, and Worry Among a U.S. National Sample

ABSTRACTBackground: Information seeking is crucial in the health behavior context. Cancer information seeking may play a key role in individuals’ perceptions and subsequent health behaviors. Purpose: The purpose of this study is to investigate the influence of cancer information seeking on perceptions of cancer worry, fatalism and risk. Methods: Data from the 2014 U.S. Health Information and National Trends Survey were used. Fatality index, lifetime risk perceptions, and cancer worry were dependent variables. Each model included cancer information seeking as the independent variable, controlling for the demographic variables (age, gender, education, income, ethnicity, and marital status), body mass index (BMI), and cancer family history. Results: A majority were females (59.76%; n = 1856). The mean age was 53 and most participants were white (52.19%). A majority had a bachelor’s degree or higher (40.11%), and 40.2% were actively seeking information on cancer. Results show that information seeking was a significant predictor of lifetime risk perceptions (β = 0.079, R2 = 0.105, P < .001) and cancer worry (β = 0.129, R2 = 0.081, P < .001). Discussion: Active cancer information-seekers were more likely to worry about getting cancer and perceive that they had a greater chance to get cancer. Translation to Health Education Practice: Health Educators are encouraged to pay closer attention to how cancer information is framed to ensure that information elicits health-enhancing attitudes and behaviors.

Trust Me, I'm a Doctor: Examining Changes in How Privacy Concerns Affect Patient Withholding Behavior.

BackgroundAs electronic health records (EHRs) become ubiquitous in the health care industry, privacy breaches are increasing and being made public. These breaches may make consumers wary of the technology, undermining its potential to improve care coordination and research.ObjectiveGiven the developing concerns around privacy of personal health information stored in digital format, it is important for providers to understand how views on privacy and security may be associated with patient disclosure of health information. This study aimed to understand how privacy concerns may be shifting patient behavior.MethodsUsing a pooled cross-section of data from the 2011 and 2014 cycles of the Health Information and National Trends Survey (HINTS), we tested whether privacy and security concerns, as well as quality perceptions, are associated with the likelihood of withholding personal health information from a provider. A fully interacted multivariate model was used to compare associations between the 2 years, and interaction terms were used to evaluate trends in the factors that are associated with withholding behavior.ResultsNo difference was found regarding the effect of privacy and security concerns on withholding behavior between 2011 and 2014. Similarly, whereas perceived high quality of care was found to reduce the likelihood of withholding information from a provider in both 2011 (odds ratio [OR] 0.73, 95% confidence interval [CI] 0.56-0.94) and 2014 (OR 0.61, 95% CI 0.48-0.76), no difference was observed between years.ConclusionsThese findings suggest that consumers’ beliefs about EHR privacy and security, the relationship between technology use and quality, and intentions to share information with their health care provider have not changed. These findings are counter to the ongoing discussions about the implications of security failures in other domains. Our results suggest that providers could ameliorate privacy and security by focusing on the care quality benefits EHRs provide.

Cancer Fatalism, Literacy, and Cancer Information Seeking in the American Public.

Information seeking is an important behavior for cancer prevention and control, but inequalities in the communication of information about the disease persist. Conceptual models have suggested that low health literacy is a barrier to information seeking, and that fatalistic beliefs about cancer may be a mediator of this relationship. Cancer fatalism can be described as deterministic thoughts about the external causes of the disease, the inability to prevent it, and the inevitability of death at diagnosis. This study aimed to examine the associations between these constructs and sociodemographic factors, and test a mediation model using the American population-representative Health Information and National Trends Survey (HINTS 4), Cycle 3 (n = 2,657). Approximately one third (34%) of the population failed to answer 2/4 health literacy items correctly (limited health literacy). Many participants agreed with the fatalistic beliefs that it seems like everything causes cancer (66%), that one cannot do much to lower his or her chances of getting cancer (29%), and that thinking about cancer makes one automatically think about death (58%). More than half of the population had “ever” sought information about cancer (53%). In analyses adjusted for sociodemographic characteristics and family cancer history, people with limited health literacy were less likely to have ever sought cancer information (odds ratio [OR] = 0.63; 0.42-0.95) and more frequently endorsed the belief that “there’s not much you can do . . .” (OR = 1.61; 1.05-2.47). This fatalistic belief partially explained the relationship between health literacy and information seeking in the mediation model (14% mediation). Interventions are needed to address low health literacy and cancer fatalism to increase public interest in cancer-related information.

Abstract 2661: Healthcare utilization by race and sex among a nationally representative sample of adults with and without a personal history of cancer

Abstract Background: Men and minorities suffer higher burdens from cancer. Healthcare utilization differences may contribute to this major public health problem. Aim: To compare utilization of healthcare services by race and sex among adults with and without a history of cancer as measured by having at least one doctor's visit within the last 12 months. Methods: We analyzed data from 7,229 responders to the 2007 Health Information and National Trends Survey (HINTS). We identified participants with and without a personal history of cancer and compared them by race and sex with having a doctor's visit within the previous 12 months. We used logistic regression models to calculate Odd Ratios (OR) and 95% confidence intervals (CI). Results: The mean age of respondents was 54.1 years, 38.8% males, 76.1% whites, 9.4% blacks, and 8.6% Hispanics. Of the respondents, 88.8% had health insurance (92.5% whites, 78.9% blacks, and 69.1% Hispanics; P value &amp;lt;0.001). Although there was no difference in health insurance coverage by sex (P value = 0.506), men were less likely to have seen a doctor within the previous 12 months (OR=0.40; 95% CI: 0.31-0.51). Cancer survivors were more likely to have seen a doctor (OR=2.70; 95% CI: 1.68-4.36), but there was no difference by race. After adjusting for age, education, race, income and insurance status, men were less likely to have seen a doctor if they did not have a personal history of cancer (Table). Conclusion: Our study suggests that men improve in their compliance to doctors’ visits only after cancer diagnosis. Targeted interventions to promote use of preventive care services by men are needed. Table: Comparison of doctors’ visit within the previous 12 months by personal history of cancer Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 2661. doi:1538-7445.AM2012-2661

A national survey of assessment trends in communication departments

Results of the survey presented in this article, concerned with how departments of communication were responding to assessment mandates, indicated that most colleges and universities consider the development of oral communication abilities a goal of their general education programs, and that this goal is most frequently operationalized as a required course for students. Course evaluations were the most common source of information on the effectiveness of requirements and programs of study. Faculty seemed more involved in the assessment process at the departmental level than at the school‐wide level. The article concludes with recommendations for better assessment of student outcomes.