non-Hispanic Black Residents Research Articles

Using the CA Opioid Overdose Surveillance Dashboard to track opioid overdose deaths

Using the CA Opioid Overdose Surveillance Dashboard to track opioid overdose deaths

Spatial accessibility to pediatric primary care in Philadelphia: an area-level cross sectional analysis

BackgroundPediatric primary care visits are a foundational element in the health maintenance of children. Differential access may be a driver of racial inequities in health. We hypothesized that pediatric primary care accessibility would be lowest in neighborhoods with higher proportion of non-Hispanic Black residents.MethodsAnnual ratios (2008–2016) of providers to pediatric population were calculated by census tract in Philadelphia, Pennsylvania. Marginal logistic regression was used to estimate the independent association between neighborhood racial composition and access to pediatric primary care controlling for confounders.ResultsIn general, low access to care was associated with greater neighborhood disadvantage (e.g., SES, % poverty, % public insurance). After controlling for neighborhood indicators of disadvantage, risk of being in the lowest quintile of access significantly increased as the percent of non-Hispanic Black residents increased.ConclusionA new measure of pediatric primary care accessibility demonstrates a persistent disparity in primary care access for predominantly non-Hispanic Black neighborhoods.

Sociodemographic factors and social determinants associated with toxicology confirmed polysubstance opioid-related deaths

Background and aimsWhile prescribed and illicit opioid use are primary drivers of the national surges in overdose deaths, opioid overdose deaths in which stimulants are also present are increasing in the U.S. We determined the social determinants and sociodemographic factors associated with opioid-only versus polysubstance opioid overdose deaths in Massachusetts. Particular attention was focused on the role of stimulants in opioid overdose deaths. MethodsWe analyzed all opioid-related overdose deaths from 2014 to 2015 in an individually-linked population database in Massachusetts. We used linked postmortem toxicology data to identify drugs present at the time of death. We constructed a multinomial logistic regression model to identify factors associated with three mutually exclusive overdose death groups based on toxicological results: opioid-related deaths with (1) opioids only present, (2) opioids and other substances not including stimulants, and (3) opioids and stimulants with or without other substances. ResultsBetween 2014 and 2015, there were 2,244 opioid-related overdose deaths in Massachusetts that had accompanying toxicology results. Toxicology reports indicated that 17% had opioids only, 36% had opioids plus stimulants, and 46% had opioids plus another non-stimulant substance. Persons older than 24 years, non-rural residents, those with comorbid mental illness, non-Hispanic black residents, and persons with recent homelessness were more likely than their counterparts to die with opioids and stimulants than opioids alone. ConclusionsPolysubstance opioid overdose is increasingly common in the US. Addressing modifiable social determinants of health, including barriers to mental health services and homelessness, is important to reduce polysubstance use and overdose deaths.

Factors Associated with Black Cancer Patients' Ability to Obtain Their Opioid Prescriptions at the Pharmacy.

Background: Black cancer patients experience pain. Barriers to opioid medications for pain may include geographic factors. This study examines neighborhood factors associated with difficulties receiving prescription opioids from pharmacies for black cancer patients. Design: A secondary data analysis of a study on opioid adherence was used to examine neighborhood-level and individual factors related to difficulties filling prescriptions for opioids. Setting/Subjects: Patients being treated for cancer pain with opioids (n = 104) were recruited. All self-identified as black, were 21 years or older, had cancer diagnoses, and had been prescribed extended release opioids. Measurements: A seven-item survey to identify problems filling opioids was completed by 98 participants along with a nine-item scale to assess perceived neighborhood characteristics. Scales of neighborhood amenities and neglect were created from the perceived neighborhood characteristics scale using principal components analysis. The 2009-2013 American Community Survey data were used to estimate the census tract percentage of non-Hispanic black residents, residents ≥25 years of age without a high school degree or equivalent, and households earning below the federal poverty level within the past 12 months. Results: Nearly 51% reported problems getting their opioids filled: 28% had to wait days and 24% had to return to the pharmacy multiple times. The main theme identified in analysis of an open-ended question was pharmacies not stocking medication. Neighborhood locations that rated higher on the amenities scale were protective for pharmacies sufficiently stocking opioids. Conclusions: Additional research on pharmacies sufficiently stocking opioid pain and neighborhood perceptions is warranted.

Oral health status of adults in North Carolina assisted living facilities.

The specific aims of this study were to describe the baseline oral health status of persons residing in North Carolina assisted living facilities and determine how identified oral health problems vary according to resident and facility demographic variables. This cross-sectional descriptive epidemiologic study used a statewide random sample of 40 assisted living facilities and a convenience sample of 854 assisted living residents. Dental hygienists and dentists conducted oral screenings on residents using the Association of State and Territorial Dental Director's Basic Screening Survey for Older Adults tool. Nearly one-third of participants were younger than 65. Overall, poorer oral health was noted for non-Hispanic black residents, Medicaid recipients, residents of small facilities (20-60 beds), and residents of facilities located in the Coastal Plains region of the state. Oral health also worsened with increasing length of residence yet seemed to improve with age. The overall rate of edentulism was 29 percent, half of whom did not have complete dentures. Nearly half (48.6 percent) of residents had untreated decay. There is a need for policy and public health programming that addresses the broad racial and socioeconomic factors that contribute to disparities among the institutionalized. Furthermore, the oral health disparities between institutionalized and community-dwelling older adults reflect the need for policy that requires and ensures access to a minimum level of oral health care throughout the duration of a resident's stay. Programming to support such policy should include development of an oral health workforce that is competent in geriatric oral health care.

Preterm birth disparities between states in the United States: an opportunity for public health interventions

Objective: To examine associations between statelevel characteristics and state-level preterm birth rates.Study design: We conducted a retrospective ecological cross-sectional study using statelevel data from 2013 to 2014 extracted from publicly available sources –the March of Dimes PeriStats database, the U.S. Census Bureau, the US Department of Education, and the US Department of Justice.Results: State-level preterm birth rates correlated with the following state characteristics: poverty rate, obesity rate, percentage of non-Hispanic Black women residents, smoking rate, percent of C − section deliveries, percent of births to women <20 years old, pregnancies receiving late/no prenatal care, and violent crimes per capita. Linear regression analysis found that only the percent of non-Hispanic Black women by state remained a significant predictor of state-level preterm birth rates after adjusting for other risk factors.Conclusions: States with higher percentages of non-Hispanic Black women had higher rates of preterm birth, even after adjusting for sociodemographic characteristics, prenatal care, and maternal health by state. These findings suggest that public health interventions that target contextual and environmental risk factors affecting non-Hispanic Black women may help to curb rising rates of preterm birth in the United States.

Differences in Social Isolation and Its Relationship to Health by Rurality.

Social isolation is an urgent threat to public health. Meanwhile, health outcomes across multiple measures are worse in rural areas, where distance to neighbors is often greater and opportunities for social interaction may be scarcer. Still, very little research examines rural-urban differences in social isolation. This study addresses that gap by examining differences in social isolation by rurality among US older adults. Using Wave 2 of the National Social Life, Health, and Aging Project data (n = 2,439), we measured differences between urban and rural (micropolitan or noncore) residents across multiple dimensions of social isolation. We also conducted multivariable analysis to assess the associations between rurality, sociodemographic characteristics, and loneliness, overall and by rurality. Finally, we conducted multivariable analysis to assess the association between social isolation and self-rated health, adjusting for rurality. Compared to urban residents, rural residents had more social relationships and micropolitan rural residents were more likely to be able to rely on family members (95.8% vs 91.3%, P < .05). Micropolitan rural residents reported lower rates of loneliness than urban residents after adjusting for sociodemographic and health characteristics (b = -0.32, P < .05), whereas noncore rural, non-Hispanic black residents had a greater likelihood of reporting loneliness (b = 4.33, P < .001). Overall, noncore and micropolitan rural residents reported less social isolation and more social relationships than urban residents. However, there were differences by race and ethnicity among rural residents in perceived loneliness. Policies and programs to address social isolation should be tailored by geography and should account for within-rural differences in risk factors.

Disparities in retail marketing for little cigars and cigarillos in Los Angeles, California

IntroductionEvidence of a concentration of cigarette advertising in predominantly low-income, non-White neighborhoods underscores the need to examine retail marketing and promotions for novel tobacco products like little cigars and cigarillos (LCCs). We sought to investigate neighborhood racial/ethnic disparities in LCC marketing at retail, including availability, advertising, price promotions, and product placement in Los Angeles, California. MethodsBetween January 2016 and April 2017, community health workers (n = 19) conducted in-person observational audits from tobacco retail stores (n = 679) located in zip codes with a high percentage of non-Hispanic White (n = 196), Black (n = 194), Hispanic/Latino (n = 189), or Korean American (n = 100) residents. To account for clustering effect of zip codes, multilevel modeling approach for a dichotomized outcome was conducted to evaluate the association between racial/ethnic neighborhood sample and dependent variables. ResultsStores located in zip codes with a high percentage of non-Hispanic Blacks had more than eight times higher odds of selling LCCs (OR = 8.10; 95% CI = 3.10–21.11 vs. non-Hispanic White), more than five times higher odds of selling flavored LCCs (OR = 5.20; 95% CI = 2.33–11.61 vs. non-Hispanic White), and more than six times higher odds of displaying storefront exterior LCC signage (OR = 6.03; 95% CI = 2.93–12.40 vs. non-Hispanic White). Stores in Hispanic/Latino and Korean American communities had about three times higher odds of selling LCCs (OR = 3.02; 95% CI = 1.15–7.93 vs. non-Hispanic White; OR = 2.99; 95% CI = 1.33–6.71 vs. non-Hispanic White). ConclusionsLCCs are heavily marketed in retail establishments in Los Angeles, with disproportionate targeting of predominantly non-White neighborhoods, especially stores in neighborhoods with a higher proportion of African Americans. Local, state, and federal flavor restrictions, minimum pack size standards, preventive messages, and campaigns could counter the influence of LCC marketing in retail establishments.

Inequities in the quality of urban park systems: An environmental justice investigation of cities in the United States

A growing body of research shows affluent White neighborhoods have more acres of parks and more park facilities than low-income ethnic minority communities in many Global North cities. Most of these investigations focused on neighborhood-level differences and did not analyze broader inequities across cities. This is a particularly significant limitation in the U.S., where changes in the political economy of parks due to a reduced local tax base have led cities to compete against each other to secure park funding from national nonprofits and public agencies. To address this gap, we examined whether the quality of urban park systems – measured through The Trust for Public Land’s ParkScore – varies depending on a city’s median income and ethnic composition. Based on multivariate regressions in which we control for features of the urban fabric, we found U.S. cities with higher median incomes and lower percentages of Latino and Non-Hispanic Black residents have higher ParkScores than other cities. Some inequities also emerged for park coverage, park spending per person, and park facilities, with majority-Latino cities being particularly disadvantaged. These findings echo the results of neighborhood-level studies in Global North contexts, suggesting neighborhood-level inequities in park provision might scale up to inequities across cities. This study contributes to environmental justice theory and advocacy by demonstrating the importance of scaling up analyses of park provision to cross-city comparisons. Implications for landscape planning, public policy, and grant-making are discussed.

Residential Racial Isolation and Spatial Patterning of Type 2 Diabetes Mellitus in Durham, North Carolina.

Neighborhood characteristics such as racial segregation may be associated with type 2 diabetes mellitus, but studies have not examined these relationships using spatial models appropriate for geographically patterned health outcomes. We constructed a local, spatial index of racial isolation (RI) for black residents in a defined area, measuring the extent to which they are exposed only to one another, to estimate associations of diabetes with RI and examine how RI relates to spatial patterning in diabetes. We obtained electronic health records from 2007-2011 from the Duke Medicine Enterprise Data Warehouse. Patient data were linked to RI based on census block of residence. We used aspatial and spatial Bayesian models to assess spatial variation in diabetes and relationships with RI. Compared with spatial models with patient age and sex, residual geographic heterogeneity in diabetes in spatial models that also included RI was 29% and 24% lower for non-Hispanic white and black residents, respectively. A 0.20-unit increase in RI was associated with an increased risk of diabetes for white (risk ratio = 1.24, 95% credible interval: 1.17, 1.31) and black (risk ratio = 1.07, 95% credible interval: 1.05, 1.10) residents. Improved understanding of neighborhood characteristics associated with diabetes can inform development of policy interventions.

Disparities in Hospital-Reported Breast Milk Use in Neonatal Intensive Care Units - United States, 2015.

Breast milk is the recommended nutrition for infants. For preterm infants, when mother's milk is not available, pasteurized donor milk is recommended (1). Non-Hispanic black mothers are at increased risk for having a preterm birth and for not breastfeeding (2,3); however, it is not known whether demographic disparities exist in the use of breast milk in neonatal intensive care units (NICUs). Data from CDC's 2015 Maternity Practices in Infant Nutrition and Care (mPINC) survey, which does not collect patient-level demographics, were linked to the 2011-2015 U.S. Census Bureau's American Community Survey (ACS)* to examine use of breast milk in NICUs based on demographic makeup of the hospital's postal code area. Among U.S. hospitals with a NICU, the use of mother's own milk and donor milk were examined by the percentage of non-Hispanic black (black) residents in the hospital postal code area, categorized as being above or below the national average (12.3%). In postal codes with >12.3% black residents, 48.9% of hospitals reported using mothers' own milk in ≥75% of infants in the NICU, and 38.0% reported not using donor milk, compared with 63.8% and 29.6% of hospitals, respectively, in postal codes with ≤12.3% black residents. Further investigation is needed to understand variations in breast milk use in NICUs. Targeted efforts to increase breast milk use in hospitals located in postal codes where the percentage of black mothers is above the national average might help ensure more equitable access to breast milk for preterm and other high-risk infants.

Neighborhood Inequalities in Hepatitis C Mortality: Spatial and Temporal Patterns and Associated Factors.

Deaths attributable to hepatitis C (HCV) infection are increasing in the USA even as highly effective treatments become available. Neighborhood-level inequalities create barriers to care and treatment for many vulnerable populations. We seek to characterize citywide trends in HCV mortality rates over time and identify and describe neighborhoods in New York City (NYC) with disproportionately high rates and associated factors. We used a multiple cause of death (MCOD) definition for HCV mortality. Cases identified between January 1, 2006, and December 31, 2014, were geocoded to NYC census tracts (CT). We calculated age-adjusted HCV mortality rates and identified spatial clustering using a local Moran's I test. Temporal trends were analyzed using joinpoint regression. A multistep global and local Poisson modeling approach was used to test for neighborhood associations with sociodemographic indicators. During the study period, 3697 HCV-related deaths occurred in NYC, with an average annual percent increase of 2.6% (p=0.02). The HCV mortality rates ranged from 0 to 373.6 per 100,000 by CT, and cluster analysis identified significant clustering of HCV mortality (I=0.23). Regression identified positive associations between HCV mortality and the proportion of non-Hispanic black or Hispanic residents, neighborhood poverty, education, and non-English-speaking households. Local regression estimates identified spatially varying patterns in these associations. The rates of HCV mortality in NYC are increasing and vary by neighborhood. HCV mortality is associated with many indicators of geographic inequality. Results identified neighborhoods in greatest need for place-based interventions to address social determinants that may perpetuate inequalities in HCV mortality.

Trends in Influenza and Pneumococcal Vaccination Among US Nursing Home Residents, 2006-2014

BackgroundInstitutionalized adults are at increased risk of morbidity and mortality from influenza and pneumococcal infection. Influenza and pneumococcal vaccination have been shown to be effective in reducing hospitalization and deaths due to pneumonia and influenza in this population. ObjectiveTo assess trends in influenza vaccination coverage among US nursing home residents from the 2005-2006 through 2014-2015 influenza seasons and trends in pneumococcal vaccination coverage from 2006 to 2014 among US nursing home residents, by state and demographic characteristics. MethodsData were analyzed from the Centers for Medicare and Medicaid Services' (CMS's) Minimum Data Set (MDS). Influenza and pneumococcal vaccination status were assessed for all residents of CMS-certified nursing homes using data reported to the MDS by all certified facilities. ResultsInfluenza vaccination coverage increased from 71.4% in the 2005-2006 influenza season to 75.7% in the 2014-2015 influenza season and pneumococcal vaccination coverage increased from 67.4% in 2006 to 78.4% in 2014. Vaccination coverage varied by state, with influenza vaccination coverage ranging from 50.0% to 89.7% in the 2014-2015 influenza season and pneumococcal vaccination coverage ranging from 55.0% to 89.7% in 2014. Non-Hispanic black and Hispanic residents had lower coverage compared with non-Hispanic white residents for both vaccines, and these differences persisted over time. ConclusionInfluenza and pneumococcal vaccination among US nursing home residents remains suboptimal. Nursing home staff can employ strategies such as provider reminders and standing orders to facilitate offering vaccination to all residents along with culturally appropriate vaccine promotion to increase vaccination coverage among this vulnerable population.

Neighborhood Stigma and Sleep: Findings from a Pilot Study of Low-Income Housing Residents in New York City

ABSTRACTThe primary objective of this study was to investigate the relationship between neighborhood stigma and sleep in a sample of low-income housing residents in New York City. Data were derived from the NYC Low-Income Housing, Neighborhoods, and Health Study (N = 120). Adults living in low-income housing completed a survey consisting of measures of neighborhood stigma, sleep quality, and sleep duration. Neighborhood stigma and sleep were self-reported. Associations between neighborhood stigma and sleep health were analyzed using generalized linear models with cluster variance estimation. Multivariable models adjusted for age, gender, race/ethnicity, income, education, employment status, obesity, the census block percentage of non-Hispanic black residents, and the census block percentage median household income. Results indicate that a reported negative media perception of the neighborhood was negatively associated with sleep quality and duration (p < 0.01). However, additional research is needed to explore neighborhood stigma as it relates to sleep

Census tract correlates of vape shop locations in New Jersey

IntroductionVape shops are opening across the USA, but little is known about the types of neighborhoods where they are located. This study explores community-level predictors of vape shop locations in New Jersey, USA. MethodsVape shops were identified in July 2015 using a validated systematic online search protocol and geocoded using Google Earth Pro. Multivariable logistic regression identified demographic and other predictors of vape shop presence at the census tract level. ResultsTobacco outlet density was consistently associated with higher odds of vape shop presence after adjusting for covariates (p<0.05). However, factors traditionally associated with tobacco retail were negatively associated with vapor outlets. Census tracts with a higher proportion of non-Hispanic black residents had significantly lower odds of having a vape shop (β=−0.03, p<0.001). DiscussionVape shops are commonly located in census tracts where tobacco retail is high, but where fewer racial minorities live. The retail environment may communicate social norms regarding vaping and ultimately influence use behaviors of community residents.

Abstract B90: What do current vaccination patterns tell us about the future of geographic and racial disparities in human papillomavirus (HPV)-related cancers?

Abstract Background: Human papillomavirus (HPV) vaccine can prevent several types of cancer, including cervical, anal, vaginal, and vulvar cancer. Widespread coverage with HPV vaccine could reduce disparities in the incidence and mortality rates of these cancers. However, preliminary evidence has shown that HPV vaccination among girls is highest in U.S. states with the lowest rates of cervical cancer mortality. We expanded on this finding and tested the hypothesis that states with higher risks of HPV-associated cancers would have lower HPV vaccine coverage levels. Methods: We gathered state-level data on HPV-related cancer risk and HPV vaccine initiation coverage for girls and boys, separately, and HPV vaccine follow-through (i.e., receipt of 3 doses among those initiating the series) for girls only. In addition, we gathered data on states' demographic composition and contact with the healthcare system. Data came from high-quality, national sources, and most data were from 2012. We calculated Pearson correlations for ecological relationships between (a) vaccination levels and (b) cancer rates, demographic composition, and contact with the healthcare system. Results: HPV vaccine initiation among girls was lower in states with higher levels of cervical cancer incidence and mortality (r=-.29 and -.46, respectively). In addition, girls' initiation was lower in states with higher proportions of non-Hispanic black residents (r=-.28) and lower proportions of higher income residents (r=.32). HPV vaccine follow-through among girls was lower in states with higher levels of cervical cancer mortality (r=-.30) and higher in states with greater levels of adolescents' contact with the healthcare system. HPV vaccine initiation among boys was lower in states with higher proportions of non-Hispanic white residents and lower proportions of residents of “other” race/ethnicity. HPV vaccine initiation among boys was not associated with states' HPV-related cancer incidence or mortality. Conclusions: HPV vaccine coverage for girls was lower in states with higher HPV-related cancer risk. As initiation among boys and girls was highly correlated, it is possible that the pattern seen among girls could develop as vaccination among boys becomes more widely accepted and coverage increases. Public health efforts should concentrate on geographic areas with higher cancer burden. Strengthening adolescent preventive healthcare use may be particularly important to increase vaccine follow-through. Cost-effectiveness analyses may overestimate the benefits of current vaccination coverage and underestimate the benefits of increasing coverage. The current patterns of HPV vaccination, especially among girls, may not be adequate to reverse the current geographic and racial/ethnic disparities in HPV-related cancer incidence and mortality. Citation Format: Jennifer L. Moss, Paul L. Reiter, Noel T. Brewer. What do current vaccination patterns tell us about the future of geographic and racial disparities in human papillomavirus (HPV)-related cancers? [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B90.

Disparities in the Availability of Farmers Markets in the United States.

Farmers markets (FM) have been proposed by researchers, policymakers, and health agencies as a potential community-level strategy to prevent obesity and reduce disparities in healthy food access in the U.S. Information about disparities in farmers market availability is scarce. This research aimed to examine county-level associations between farmers market (FM) availability and demographic, socioeconomic, health, and environmental measures in an effort to determine if disparities in availability exist in the U.S. An ecological study of 3,135 U.S. counties was conducted in 2013 using 2009-2010 data extracted from the United States Department of Agriculture Food Environment Atlas. Logistic regression and Poisson regression models were used to determine associations between county-level FM availability and measures such as percentage of non-Hispanic black residents, median household income, and number of grocery stores per 100,000 residents (i.e., per capita). Regression models were stratified by metro county status and all analyses were adjusted for state-level clustering. There were 1,774 (56.6%) counties with at least one FM available. Median household income was associated with increased odds of having at least one FM available among non-metro counties, but not metro counties. Percentage of non-Hispanic black residents and residents living in poverty were negatively associated with per capita FMs among metro and non-metro counties. Per capita fast food restaurants was negatively associated with per capita FMs among metro counties. Disparities in FM availability exist in the U.S. More research on the behavioral and health implications of farmers market availability should be conducted.

Effectiveness of a Walking Group Intervention to Promote Physical Activity and Cardiovascular Health in Predominantly Non-Hispanic Black and Hispanic Urban Neighborhoods

The purpose of this study was to evaluate the effectiveness of the Walk Your Heart to Health (WYHH) intervention, one component of the multilevel Community Approaches to Cardiovascular Health: Pathways to Heart Health (CATCH:PATH) intervention designed to promote physical activity and reduce cardiovascular risk among non-Hispanic Black and Hispanic residents of Detroit, Michigan. The study was designed and implemented using a community-based participatory research approach that actively engaged community residents, health service providers and academic researchers. It was implemented between 2009 and 2012. WYHH was a 32-week community health promoter-facilitated walking group intervention. Groups met three times per week at community-based or faith-based organizations, and walked for 45 to 90 minutes (increasing over time). The study used a cluster randomized control design to evaluate effectiveness of WYHH, with participants randomized into intervention or lagged intervention (control) groups. Psychosocial, clinical, and anthropometric data were collected at baseline, 8, and 32 weeks, and pedometer step data tracked using uploadable peisoelectric pedometers. Participants in the intervention group increased steps significantly more during the initial 8-week intervention period, compared with the control group (β = 2004.5, p = .000). Increases in physical activity were associated with reductions in systolic blood pressure, fasting blood glucose, total cholesterol, waist circumference and body mass index at 8 weeks, and maintained at 32 weeks. The WYHH community health promoter-facilitated walking group intervention was associated with significant reductions in multiple indicators of cardiovascular risk among predominantly Hispanic and non-Hispanic Black participants in a low-to-moderate income urban community. Such interventions can contribute to reductions in racial, ethnic, and socioeconomic inequities in cardiovascular mortality.

Correlates of human papillomavirus vaccine coverage: a state-level analysis.

We tested the hypothesis that states with higher rates of cancers associated with human papillomavirus (HPV) would have lower HPV vaccine coverage. We gathered state-level data on HPV-related cancer rates and HPV vaccine initiation coverage for girls and boys, separately, and HPV vaccine follow-through (i.e., receipt of 3 doses among those initiating the series) for girls only. In addition, we gathered state-level data on demographic composition and contact with the health care system. We calculated Pearson correlations for these ecological relationships. Human papillomavirus vaccine initiation among girls was lower in states with higher levels of cervical cancer incidence and mortality (r = -0.29 and -0.46, respectively). In addition, vaccine follow-through among girls was lower in states with higher levels of cervical cancer mortality (r = -0.30). Other cancer rates were associated with HPV vaccine initiation and follow-through among girls, but not among boys. Human papillomavirus vaccine initiation among girls was lower in states with higher proportions of non-Hispanic black residents and lower proportions of higher-income residents. Human papillomavirus vaccine follow-through was higher in states with greater levels of adolescents' contact with the health care system. Human papillomavirus vaccine coverage for girls was lower in states with higher HPV-related cancer rates. Public health efforts should concentrate on geographic areas with higher cancer rates. Strengthening adolescent preventive health care use may be particularly important to increase vaccine follow-through. Cost-effectiveness analyses may overestimate the benefits of current vaccination coverage and underestimate the benefits of increasing coverage.

Melanoma in skin of color in Connecticut: an analysis of melanoma incidence and stage at diagnosis in non-Hispanic blacks, non-Hispanic whites, and Hispanics.

The incidence of melanoma is increasing in Caucasians and in Hispanic subgroups in California and Florida. There is a paucity of information regarding melanoma incidence, stage at diagnosis, and other patient and tumor factors among minority subgroups in the northeast USA. This report examines melanoma in non-Hispanic white, non-Hispanic black, and Hispanic residents of Connecticut. Trends in age-adjusted melanoma incidence rates (1992-2007) and the corresponding annual percentage changes in rates were calculated for Connecticut residents by race and Hispanic ethnicity. The racial/ethnic variation was evaluated for a number of patient and tumor characteristics: gender, age at diagnosis, marital status, anatomic site, histology, ulceration, Breslow thickness, and stage at diagnosis. Statistical significance at the 95% level was assessed using confidence intervals (95% CIs) and Pearson's chi-squared tests. Between 1992 and 2007, melanoma incidence increased by 4.1% per year in non-Hispanic whites in Connecticut (95% CI 3.1-5.1%; P<0.05). Melanoma incidence remained relatively stable for Hispanics and non-Hispanic blacks over the same period. A significantly higher proportion of advanced (regional and distant) melanomas were diagnosed in non-Hispanic blacks (19.1%) and Hispanics (17.1%) than in non-Hispanic whites (8.7%) (P<0.001). A significantly higher proportion of advanced melanomas were diagnosed in non-Hispanic blacks and Hispanics than in non-Hispanic whites. There is a growing need to educate patients and healthcare providers of the necessity for skin cancer surveillance regardless of the race of the patient.