Pooled Cross-sectional Study Research Articles

Preventive Resilience: The Role of Long-Term Care Organizations’ Collective Agency Capacity

Abstract Background The COVID-19 pandemic has intensified pressure on healthcare organizations (HCOs), particularly long-term care organizations (LTCOs. An HCO’s resilience is closely linked to its proactive ability to address and manage both novel and persistent stressors. This proactive approach, termed ‘preventive resilience,’ involves preemptively averting stressors to safeguard the organization’s resilience mechanisms. Objectives The aim of this presentation is to examine the hypothesis asserting that preventive resilience is, to a significant extent, nurtured by the collective capacity of a Long-Term Care Organization (LTCO) to act and react as a cohesive social system. This collective agency capacity of an LTCO is posited to play a pivotal role in fortifying preventive resilience of HCOs. Methods We conducted a pooled cross-sectional study on long-term care organizations in Germany during the initial (April 2020) and subsequent waves of the pandemic (December 2020-January 2021). Our sample comprised 503 leaders during the first wave and 294 leaders during the second wave from various long-term care organizations. The study involved top managers of these facilities reporting their perceptions of the collective agency capacity of the LTCO, assessed using the AGIL short scale. Additionally, they were asked to gauge the facility’s exposure to both general non-pandemic demands and pandemic-specific demands. Results We discovered a notable inverse relationship between leaders’ perceptions of the collective agency capacity within their Long-Term Care Organizations (LTCO) and their assessments of general demands. However, no significant association was observed between the agency capacity and the magnitude of pandemic-specific demands. Conclusions The findings tentatively endorse the notion that cultivating the collective agency capacity of nursing facilities enhances their resilience to familiar general demands, particularly during periods of exceptional stress. Key messages • Cultivating the collective agency capacity of nursing facilities enhances their resilience to familiar general demands. • The collective capacity to act and react in a cohesive way is a general resistance resource of healthcare organizations.

GLP-1 Receptor Agonist and SGLT2 Inhibitor Prescribing in People With Type 1 Diabetes

This pooled cross-sectional study explores prescribing rates for glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter 2 inhibitors among US patients with type 1 diabetes.

Food insecurity and food bank use: who is most at risk of severe food insecurity and who uses food banks?

To identify (1) who experiences food insecurity of differing severity and (2) who uses food banks in England, Wales and Northern Ireland; (3) whether the same groups experience food insecurity and use food banks; and (4) to explore country- and region-level differences in food insecurity and food bank use. This pooled cross-sectional study analysed the characteristics of adults experiencing food insecurity of differing severity using generalised ordinal logistic regression models and the characteristics of adults using food banks using logistic regression models, using data from three waves of the Food and You 2 surveys, 2021-2023. England, Wales and Northern Ireland. 18 557 adults. 20·8 % of respondents experienced food insecurity in the past 12 months, and 3·6 % had used a food bank. Food insecurity was associated with income, working status, respondent age, family type, ethnicity, country, long-term health conditions, food hypersensitivity, urban-rural status and area-level deprivation. Severe food insecurity was concentrated among respondents with long-term health conditions and food hypersensitivities. Food bank use was more prevalent among food insecure respondents and unemployed and low-income respondents. Neither outcome showed clear geographical variation. Certain groups experienced an elevated likelihood of food insecurity but did not report correspondingly greater food bank use. Food insecurity is unevenly distributed, and its nutrition and health-related consequences demonstrate that food insecurity will intensify health inequalities. The divergence between the scale of food insecurity and food bank use strengthens calls for adequate policy responses.

Hazardous alcohol consumption across different industries in Sweden: a pooled cross-sectional study.

The current study aims to (i) examine differences in hazardous alcohol consumption across different industries in Sweden and (ii) assess to what degree any such difference can be attributed to a differential distribution of nicotine use, health, and work environments among individuals working in these industries. A pooled cross-sectional study was conducted including all participants of the survey of Health, Work Environment, and Lifestyle Habits between 2012 and 2023 (n = 54378), collected by an occupational health service company (Feelgood). The survey contained self-reported information on alcohol use, industry, nicotine use, health, and work environment. Crude and adjusted odds ratios with 95% confidence intervals were obtained by pooled logistic regression analyses. Hazardous alcohol use was highly prevalent in the current study population (37%), especially among individuals in the accommodation/food service, arts/entertainment/recreation, and the construction industry. Compared to individuals working in education, individuals in these industries had >1.6-fold increased odds of reporting hazardous alcohol consumption. Differences in nicotine use and physical work environment between the industries explained some of the differences in hazardous alcohol consumption between industries, while differences in health and psychosocial work environment had limited effects on the estimates. We identified several industries in the Swedish workforce where hazardous alcohol use is highly prevalent. While differences in nicotine use, health, and work environment explained a part of these risk differences, most of the risk differences remained.

Geography of the Underserved: The Contribution of Rural Non-Trauma Hospitals to Trauma Care.

To determine the proportion and characteristics of injured rural residents treated at urban trauma centers (TCs), urban non-trauma centers (NTCs), rural TCs, and rural NTCs. Timely treatment at a designated trauma center improves outcomes for patients with serious injuries, but rural residents have limited access to designated trauma centers. Rural non-trauma centers may constitute an underrecognized source of trauma care. We used the National Emergency Department Sample to conduct a retrospective, pooled cross-sectional study of ED visits among rural residents with injury severity score (ISS) ≥ 9 (indicating at least moderate injury). Hospitals were designated as a trauma (TC) or non-trauma center (NTC) and as rural or urban. We compared management, disposition, and outcomes among hospital types. Of 748,587 injured rural residents from 2016-2020, 384,113 (51.3%) were treated in rural NTCs, 232,845 (31.1%) in urban TCs, 116,493 (15.6%) in urban NTCs, and 15,137 (2.0%) in rural TCs. Injuries treated at rural NTCs were moderate in severity (ISS 9-15) in 76.6% of visits, severe (ISS 16-25) in 15.7%, and very severe (ISS > 25) in 1.1%. Urban TCs saw the highest proportion of very severe injuries (17.3%). Rural NTCs managed 77.5% of visits definitively, discharging 72.8%. They transferred 21.9% of patients. Length of stay was longest and hospital charges highest for patients treated in urban TCs, which also performed the most procedures. Rural NTCs had the shortest length of stay and lowest mean charges. Rural non-trauma centers provided initial care for more than half of injured rural residents, including 2 in 5 of those with the most severe injuries, and managed more than 3 in 4 definitively. These hospitals may be an under-recognized component of the US trauma system.

Sex-related differences in self-efficacy of patients with heart failure: a pooled cross-sectional study of the German Competence Network Heart Failure.

To assess the level of self-efficacy in patients with heart failure (HF), and identify differences between important subgroups including sex, and to identify the determinants of high self-efficacy. This was a pooled cross-sectional analysis of 2,030 patients from four prospective studies conducted within the German Competence Network Heart Failure. We used the Self-efficacy Subscale and the Overall Summary Score (OSS) of the Kansas City Cardiomyopathy Questionnaire (KCCQ-23) to assess self-efficacy and health-related quality of life. The cut-off of 75 score points was used for the dichotomization into high (≥75) vs low (<75) self-efficacy. Depressive symptoms were measured by the Patient Health Questionnaire (PHQ-9). A total of 1,615 patients with HF provided complete self-efficacy scores: mean age 66.6±12.3 years, 431 (27%) women. Mean self-efficacy was 67.5±24.9, with 907 patients (56.2%) showing high self-efficacy and 708 patients (43.8%) showing low self-efficacy. Men had higher self-efficacy scores than women (68.7±24.5 vs. 64.2±26.0; p=0.001). Multivariable logistic regression identified KCCQ-OSS (OR per 5-point increase 1.08, 95%CI 1.04-1.12), female sex (OR 0.72, 95%CI 0.56-0.94), depressive symptoms (OR per 3-point increase in PHQ-9 0.90, 95%CI 0.83-0.98), and acute HF (0.46, 95% CI 0.34-0.62) as important predictors of high self-efficacy. In patients with HF, women seemed to exhibit lower self-efficacy than men. Health-related quality of life and psychological well-being were dominant determinants of self-efficacy. Future studies should investigate the role of self-efficacy as a therapeutic target for tailored and sex-specific nursing interventions.

The relationship between hospital patient safety culture and performance on Centers for Medicare & Medicaid Services value-based purchasing metrics.

Despite the intense policy focus on reducing health-care-associated conditions, adverse events in health care settings persist. Therefore, evaluating patient safety efforts and related health policy initiatives remains critical. The aim of this study was to explore the relationship between hospital patient safety culture and hospital performance on Centers for Medicare & Medicaid Services (CMS) Hospital Value-Based Purchasing (HVBP) metrics. A pooled cross-sectional study design was used utilizing three secondary datasets from 2018 and 2021: the Hospital Survey on Patient Safety Culture, the American Hospital Association annual survey, and the Hospital Compare data from CMS. We used two multivariable linear regression models to examine the relationship between organizational patient safety culture and hospital performance. The dependent variables included the overall CMS total performance score (TPS) and the four individual TPS domain scores. Hospital patient safety culture, the independent variable, was operationalized using two measures from the Hospital Survey on Patient Safety Culture: (a) the domain score of overall perceptions of patient safety and (b) the patient safety grade. We observed positive and significant associations between hospital patient safety culture and a hospital's overall TPS and the "patient and community engagement" and "safety" domains. Findings suggest that building a strong patient safety culture has the potential to lead health care organizations to achieve high performance on HVBP metrics. Our findings have important policy implications for both the future of CMS HVBP as a motivator of patient safety and how health care managers integrate culture change into programs to meet external quality metrics.

Prescribing antibiotics for children with dengue infection in Taiwan: who are at risk and who are high prescribers?

Inappropriate antibiotic use contributes to antimicrobial resistance, a global public health threat. The non-specific manifestations of dengue, itself a growing public health threat, lead to avoidable empiric antibiotic prescription, particularly in children. In this national pooled population-based cross-sectional study, we evaluated child and physician characteristics associated with antibiotics prescription in confirmed dengue cases in Taiwan. Linking national health care insurance claims and reports of confirmed dengue cases from 2008 to 2015, there were 7086 children with confirmed dengue with 21 744 outpatient visits and 2520 inpatient admissions. We assessed the presence of antibiotic prescription in outpatient and inpatient settings separately a week before or after the confirmation date. Logistic regression models with generalized estimating equations were applied to identify patient, practitioner, and other factors associated with antibiotic prescription. A total of 29.4% of children <18 years old with dengue who did not have a concomitant bacterial infection were prescribed antibiotics during the 14-day assessment period. Antibiotics prescription was reduced from 13.5% to 6.3% and from 43.2% to 19.3% in outpatient and inpatient settings, respectively, after dengue was confirmed. Young children were more likely to receive antibiotics. Significant variations in antibiotic prescribing across physicians were observed only in outpatient settings: physicians ≥60 years old and physicians practicing at clinics and in non-urban facilities were more likely to prescribe antibiotics. Antibiotics were less likely to be prescribed during an exceptional 2-year epidemic than in other years. Antibiotic prescribing for dengue, an arboviral infection affecting half of the global population, was shown to occur in 29% of paediatric cases in Taiwan. That potentially avoidable antibiotic consumption could be reduced by improving antibiotic stewardship, informed by understanding the conditions under which antibiotics are prescribed and the availability of prevention strategies for viral diseases, including dengue. We identified a number of such factors in this national population-based study.

Factors influencing online learning intentions of students: A pooled cross-sectional study in Vietnam for years 2020 and 2021

The COVID-19 pandemic precipitated a shift to online learning in many institutions-as a standard practice. Factors influencing its efficacy affect student behavior and future intentions. A cross-sectional study in Vietnam over 2 years assessed changes in student attitudes towards online learning from 2020 to 2021. Data gathered through online surveys, included 161 participants in 2020 and 395 in 2021 (total of 556 students), and were analysed using structural equation modeling. Results indicate perceived enjoyment (PE) as the primary factor influencing online learning intentions, with perceived usefulness (PU) gaining significance from 2020 to 2021. This shift suggests a transition in student mindsets towards online learning. Hence, institutions should adapt courses to optimize both enjoyment and utility, embracing technological evolution.

Characteristics of first-time users of the nursing small-scale multifunctional home care service: a pooled cross-sectional study using Japanese long-term care insurance claims data from 2012 to 2019

ObjectivesIn April 2012, the Japanese government launched a new nursing service called the nursing small-scale multifunctional home care (NSMHC) to meet the nursing care demands of individuals with moderate-to-severe activities...

The Association of Retinal Disease with Vision Impairment and Functional Status in Medicare Patients

Background: The association of neovascular age-related macular degeneration (nAMD), diabetic macular edema (DME), and retinal vein occlusion (RVO) with functional status in the general Medicare population are not well established. Objectives: This study examined patient-reported survey data linked with Medicare claims to describe the burden of these vision-threatening retinal diseases (VTRDs) among Medicare beneficiaries. Methods: Medicare Current Beneficiary Survey data linked with Medicare Fee-for-Service claims data from 2006 to 2018 were used in a nationally representative retrospective pooled cross-sectional population-based comparison study. Outcomes between community-dwelling beneficiaries with nAMD (n = 1228), DME (n = 101), or RVO (n = 251) were compared with community-dwelling beneficiaries without any VTRDs (n = 104 088), controlling for baseline demographic and clinical differences. Beneficiaries with a diagnosis of nAMD, DME, or RVO during the data year were included; those with other VTRDs were excluded. Outcomes included vision function and loss, overall functioning as assessed by difficulties with activities of daily living (ADLs) and instrumental ADLs (iADLs), anxiety/depression, falls, and fractures. Results: In patient cohorts with nAMD, DME, and RVO, approximately one-third (34.2%-38.3%) reported “a little trouble seeing” (vs 28.3% for controls), and 26%, 17%, and 9%, respectively, reported “a lot of trouble seeing/blindness” (vs 5% of controls). Difficulty walking and doing heavy housework were the most reported ADLs and iADLs, respectively. Compared with those without VTRDs, beneficiaries with nAMD had higher odds of diagnosed vision loss (odds ratio [OR], 5.39; 95% confidence interval, 4.06-7.16; P &lt; .001) and difficulties with iADLs (odds ratio, 1.41; 95% confidence interval, 1.11-1.80; P = .005); no differences were observed for DME or RVO vs control. After adjusting for age, sex, race/ethnicity, poverty status, comorbidities, and other relevant covariates, nAMD, DME, and RVO were not significantly associated with anxiety/depression, falls, or fractures. Discussion: Patients with nAMD or DME were more likely to report severe visual impairment than those without VTRDs, although only those with nAMD were more likely to be diagnosed with vision loss. Conclusions: Patients with nAMD continue to experience more vision impairment and worse functional status compared with a similar population of Medicare beneficiaries despite availability of therapies like antivascular endothelial growth factor to treat retinal disease.

The Association of Retinal Disease with Vision Impairment and Functional Status in Medicare Patients.

Background: The association of neovascular age-related macular degeneration (nAMD), diabetic macular edema (DME), and retinal vein occlusion (RVO) with functional status in the general Medicare population are not well established. Objectives: This study examined patient-reported survey data linked with Medicare claims to describe the burden of these vision-threatening retinal diseases (VTRDs) among Medicare beneficiaries. Methods: Medicare Current Beneficiary Survey data linked with Medicare Fee-for-Service claims data from 2006 to 2018 were used in a nationally representative retrospective pooled cross-sectional population-based comparison study. Outcomes between community-dwelling beneficiaries with nAMD (n = 1228), DME (n = 101), or RVO (n = 251) were compared with community-dwelling beneficiaries without any VTRDs (n = 104 088), controlling for baseline demographic and clinical differences. Beneficiaries with a diagnosis of nAMD, DME, or RVO during the data year were included; those with other VTRDs were excluded. Outcomes included vision function and loss, overall functioning as assessed by difficulties with activities of daily living (ADLs) and instrumental ADLs (iADLs), anxiety/depression, falls, and fractures. Results: In patient cohorts with nAMD, DME, and RVO, approximately one-third (34.2%-38.3%) reported "a little trouble seeing" (vs 28.3% for controls), and 26%, 17%, and 9%, respectively, reported "a lot of trouble seeing/blindness" (vs 5% of controls). Difficulty walking and doing heavy housework were the most reported ADLs and iADLs, respectively. Compared with those without VTRDs, beneficiaries with nAMD had higher odds of diagnosed vision loss (odds ratio [OR], 5.39; 95% confidence interval, 4.06-7.16; P < .001) and difficulties with iADLs (odds ratio, 1.41; 95% confidence interval, 1.11-1.80; P = .005); no differences were observed for DME or RVO vs control. After adjusting for age, sex, race/ethnicity, poverty status, comorbidities, and other relevant covariates, nAMD, DME, and RVO were not significantly associated with anxiety/depression, falls, or fractures. Discussion: Patients with nAMD or DME were more likely to report severe visual impairment than those without VTRDs, although only those with nAMD were more likely to be diagnosed with vision loss. Conclusions: Patients with nAMD continue to experience more vision impairment and worse functional status compared with a similar population of Medicare beneficiaries despite availability of therapies like antivascular endothelial growth factor to treat retinal disease.

Breast cancer screening among Medicare Advantage enrollees with dementia

BackgroundThe decision to screen for breast cancer among older adults with dementia is complex and must often be individualized, as these individuals have an elevated risk of harm from over-screening. Medicare beneficiaries with dementia are increasingly enrolling in Medicare Advantage plans, which typically promote receipt of preventive cancer screening among their enrollees. This study examined the utilization of breast cancer screening among Medicare enrollees with dementia, in Medicare Advantage and in fee-for-service Medicare.MethodsWe conducted a pooled cross-sectional study of women with Alzheimer’s disease and related dementias or cognitive impairment who were eligible for mammogram screening. We used Medicare Current Beneficiary Survey data to identify utilization of biennial mammogram screening between 2012 and 2019. Poisson regression models were used to estimate prevalence ratios of mammogram utilization and to calculate adjusted mammogram rates for Medicare Advantage and fee-for-service Medicare enrollees with dementia, and further stratified by rurality and by dual eligibility for Medicare and Medicaid.ResultsMammogram utilization was 16% higher (Prevalence Ratio [PR] 1.16; 95% CI: 1.05, 1.29) among Medicare Advantage enrollees with dementia, compared to their counterparts in fee-for-service Medicare. Rural enrollees experienced no significant difference (PR 0.99; 95% CI: 0.72, 1.37) in mammogram use between Medicare Advantage and fee-for-service Medicare enrollees. Among urban enrollees, Medicare Advantage enrollment was associated with a 21% higher mammogram rate (PR 1.21; 95% CI: 1.09, 1.35). Dual-eligible Medicare Advantage enrollees had a 34% higher mammogram rate (PR 1.34; 95% CI: 1.10, 1.63) than dual-eligible fee-for-service Medicare enrollees. Among non-dual-eligible enrollees, adjusted mammogram rates were not significantly different (PR 1.11; 95% CI: 0.99, 1.24) between Medicare Advantage and fee-for-service Medicare enrollees.ConclusionsMedicare beneficiaries age 65–74 with Alzheimer’s disease and related dementias or cognitive impairment had a higher mammogram use rate when they were enrolled in Medicare Advantage plans compared to fee-for-service Medicare, especially when they were dual-eligible or lived in urban areas. However, some Medicare Advantage enrollees with Alzheimer’s disease and related dementias or cognitive impairment may have experienced over-screening for breast cancer.

Mental healthcare access among US adults with vision impairment and depression and/or anxiety symptoms

BackgroundAlthough individuals with vision impairment are at greater risk for depression and anxiety, there has been limited study of mental healthcare utilization among this population. ObjectivesTo address this gap, this pooled cross-sectional study estimates the prevalence of mental healthcare utilization among individuals with vision impairment during the COVID-19 pandemic. MethodsWe calculated adjusted relative risk ratios and 95% confidence intervals of depression and/or anxiety symptoms and mental healthcare utilization using multinomial logistic regression, accounting for demographics, social determinants of health, and survey week. The population-based, U.S. Census Bureau Household Pulse Survey was administered April 2021–March 2022. Participants included 800,935 US adults (weighted population: 174,598,530) ResultsAdjusting for other factors, adults with vision impairment were more likely to report depression symptoms (RRR: 2.33; 95% CI: 2.03–2.68), anxiety symptoms (RRR: 2.12; 95% CI: 1.94–2.33, and comorbid depression and anxiety symptoms (RRR: 3.77; 95% CI: 3.51–4.04) compared with individuals with no vision impairment. Among individuals reporting anxiety or depression symptoms, individuals with vision impairment (RRR: 1.46; 95% CI: 1.35–1.59) were more likely to lack of mental healthcare utilization compared with individuals with no vision impairment. ConclusionFindings suggest that individuals with vision impairment are at increased risk for depression and/or anxiety symptoms and report reduced mental healthcare utilization compared with individuals without vision impairment. Additional programs and policies are needed to improve mental healthcare utilization among individuals with vision impairment and depression and/or anxiety symptoms, such as increased telehealth accessibility and coordination of behavioral health and ophthalmology services.

Patient Engagement Functionalities' Influence on Quality Outcomes: The Road via EHR Presence.

Patients engaged in self-care through information technology can potentially improve the quality of healthcare they receive. This study aimed to examine how electronic health record (EHR) system functionalities help hospitals mediate the impact of patient engagement on quality outcomes-notably, readmission rates. A pooled cross-sectional study design employed data containing 3,547 observations from general acute care hospitals (2014-2018). The breadth of patient engagement functionalities adopted by a hospital was used as the independent variable and the degree of EHR presence was used as the mediating variable. Mean time to readmission for acute myocardial infarction (AMI), pneumonia, and heart failure were the dependent variables. The Baron and Kenny method was used to test mediation. Patient engagement was associated with reduced AMI readmission rates both directly and via EHR system presence. Mediation effects were present, in that a 1-unit increase in patient engagement through EHR system presence was associated with a 0.33% decrease in AMI readmission rates (p <.05). For other disease categories (heart failure and pneumonia), a significant effect was not found. For hospitals with a comprehensive EHR system, patient engagement through information technology can potentially reduce readmission rates for some diseases. More research is needed to determine which specific clinical conditions are amenable to quality improvement through patient engagement. Synergies between patient engagement functionalities and an EHR system positively affect quality outcomes. Therefore, practitioners and hospital managers should leverage hospital investments made in their EHR system infrastructure and use it to engage patients in self-care.

EXPLORING THE ASSOCIATION BETWEEN CONTRACT NURSE STAFFING AND NURSE TURNOVER IN NURSING HOMES

Abstract NHs face a significant problem with nurse staffing---a critical factor in providing high-quality care to residents. Although contract nurse staffing in NHs may provide a relatively flexible option to address acute nurse shortages, it raises its own challenges including requirement of increased supervision, lower levels of teamwork, and increased workload for the permanent staff. This may lead to disenchantment of the remaining nursing staff, increased turnover---a perfect vicious cycle. Therefore, we examined whether higher ratios of contract nurse utilization were associated with higher nurse turnover rates (RNs, LPNs, and CNAs). Employing a pooled cross-sectional observational study design, we extracted secondary data from PBJ nurse staffing, Nursing Home Compare, Rural-urban commuting area (RUCA) codes, and American Community Survey (ACS) for the period 2017-2021. We employed multivariate mixed-effects maximum likelihood regression to estimate the relationship between the ratios of contract nurses and nurse turnover rates while controlling for organizational/community variables. We ran three separate regressions for RNs, LPNs, and CNAs. Our results suggest that NHs with a high proportion of contract nurses had higher nurse turnover rates for all the three types of staffing (RNs, LPNs, and CNAs). Moreover, NHs with high RN turnover rates had low RN staffing, higher CNA staffing, lower occupancy rates, and higher share of Medicaid residents. High nurse turnover can adversely affect resident outcomes—for instance, due to reduced continuity of care. As such, it is important to closely monitor contract nurse staffing levels and their implications on staffing and resident outcomes.

CONTRACT NURSE UTILIZATION AND FACILITY AND COMMUNITY FACTORS

Abstract While NHs have long been plagued by nursing staff shortages, the situation has further deteriorated with the COVID 19 pandemic. The NH industry has attempted to address the persistent shortage of nursing staff by increasingly relying on contract nurse staffing. Research suggests that the increased utilization of contract nurses may have negative implications for NH quality and financial performance. However, all NHs are not equally likely to utilize nurse contract staffing. For instance, potentially, NHs with poorer quality of care and financial challenges may be forced to rely more on contract nurse staffing. The primary purpose of this paper is to explore the antecedents---facility and community factors---associated with increased utilization of nurse contract staffing. Employing a pooled cross-sectional observational study design, we extracted secondary data from the PBJ nurse staffing, Nursing Home Compare, Rural-urban commuting area (RUCA) codes, and the American Community Survey (ACS) for the period 2017-2021. To test the relationship between the ratios of contract nurses and facility/community factors, we employed multivariate mixed-effects maximum likelihood regression. We ran three separate regressions for RNs, LPNs, and CNAs. Our results suggest that among facility level factors, NHs with more beds, higher occupancy rates, and higher proportion of Medicare residents were generally more likely to employ contract nurse staffing with some minor differences across the three models (RNs, LPNS, CNAs). Among community factors, location in micropolitan/small town areas, higher poverty rates, and higher education levels were positively associated with nurse contract utilization. Policy and managerial implications are discussed.

Abstract C140: A population-based analysis of awareness and knowledge of HPV and HPV vaccine among Asian American adults by origin group, 2014-2019

Abstract Background: Awareness and knowledge of human papillomavirus (HPV) and HPV vaccine are critical antecedents of HPV vaccine uptake. While emerging literature has examined racial and ethnic differences in these areas, most either exclude Asian Americans, subsume them under the category of “other,” or aggregate all origin groups under a single category of “Asians.” To fill this gap in the literature regarding data disaggregation, we conducted an analysis of awareness and knowledge of HPV, the HPV vaccine, and HPV-related cancers among six Asian origin groups (Chinese, Filipinos, Indians, Japanese, Koreans, and Vietnamese), using nationally representative samples. Methods: We performed a pooled cross-sectional study utilizing the Health Information National Trend Survey data (HINTS-4 cycle 4 [2014], HINTS-5 cycles 1-3 [2017-2019]), a nationally representative survey administered by the National Cancer Institute. We analyzed questions about knowledge of HPV, the HPV vaccine, and the facts that HPV causes cervical, oral, anal, and penile cancers by race and/or ethnicity. The sample included those who self-reported as Chinese, Filipino, Indian, Japanese, Korean, or Vietnamese origins; non-Hispanic White (NHW) respondents were the reference group. We used survey-design adjusted Wald chi-square tests. Results: A total of 8,865 non-Hispanic White respondents and 623 Asian respondents were included in this study. Significantly lower proportions of most Asian origin groups (Chinese 45.5%; Indian 45.6%; Korean 39.7%; and Vietnamese 43.5%) had heard of HPV compared with NHW counterparts (69.4%). Significantly lower proportions of Chinese (50.9%), Filipino (47.0%) Korean (46.1%), and Vietnamese (38.8%) respondents had heard of the HPV vaccine compared with NHW respondents (68.1%). Significantly lower proportions of Chinese (41.0%), Indian (36.2%), Korean (32.9%), and Vietnamese (30.6%) respondents knew that HPV causes cervical cancer compared with NHW (55.7%). Significantly lower proportions of Chinese and Vietnamese respondents knew that HPV causes anal and oral cancers, and significantly lower proportions of Indian respondents knew that HPV causes penile cancer, when compared to NHW counterparts. Discussion: Most Asian origin groups had lower knowledge of HPV-related facts, with varying magnitudes, compared with NHW counterparts. Vietnamese and Chinese respondents had significantly lower knowledge compared with NHW respondents for 5 out of 6 questions. For most questions, Vietnamese was the group with the lowest proportions of respondents reporting knowledge. Heterogeneity in HPV-related knowledge suggests the need to culturally tailor interventions about the HPV vaccine in appropriate languages to effectively reach different Asian origin groups, with particular attention to those with low awareness. Continued monitoring of HPV-related knowledge with disaggregated data collection for Asian origin groups is critical for efforts to increase educational outreach, combat vaccine misinformation, and improve HPV vaccine uptake. Citation Format: Milkie Vu, Yenan Zhu, Duy D. Trinh, Young-Rock Hong, Ryan Suk. A population-based analysis of awareness and knowledge of HPV and HPV vaccine among Asian American adults by origin group, 2014-2019 [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C140.

Abstract A074: Cancer fatalism among Asian American adults by origin group, 2014-2022

Abstract Background: Cancer fatalism encompasses beliefs about external causes of cancer and the perceived inability of humans to prevent it. Existing research suggests that individuals with higher levels of cancer fatalism are less likely to engage in cancer prevention behaviors or adhere to cancer screening practices. However, limited information exists regarding the prevalence of cancer fatalism within various Asian origin groups. Understanding whether this prevalence varies by origin group can offer valuable insights for developing strategies to enhance beliefs and knowledge about cancer among these populations, ultimately leading to improved health outcomes. To fill this gap in the literature, we conduct a disaggregated analysis of cancer fatalism among Asian origin groups (Chinese, Filipino, Indian, Vietnamese, and other Asian respondents), using nationally representative samples. Methods: We performed a pooled cross-sectional study utilizing the Health Information National Trend Survey data (HINTS-4 cycle 4 [2014], HINTS-5 cycles 1-3 [2017-2019], and HINTS-6 [2022]), a nationally representative survey administered by the National Cancer Institute. We analyzed respondents’ agreement to two items: “It seems like everything causes cancer”; and “There’s not much you can do to lower your chances of getting cancer.” We used a survey-design adjusted Wald chi-square test for bivariate analyses. Results: The sample included 234 Chinese respondents, 173 Filipino respondents, 185 Indian respondents, 97 Vietnamese respondents, and 222 other Asian respondents (e.g., Korean, Japanese). Significantly lower proportions of Indian respondents (38.9%; 95% CI 26.1 – 51.8%) endorsed the statement “It seems like everything causes cancer,” when compared with Vietnamese respondents (70.4%; 95% CI 54.9% – 86.0%) and Filipino respondents (76.2%; 95% CI 65.1% – 87.4%). Additionally, lower proportions of Indian and Chinese respondents endorsed the statement “There’s not much you can do to lower your chances of getting cancer” when compared with Vietnamese and Filipino respondents, though these differences did not reach statistical significance. Conclusions: Our study represents one of the first efforts to use nationally representative data to explore disaggregated prevalence of cancer fatalism beliefs among Asian American origin groups. Filipino adults exhibit nearly double the prevalence of one of the cancer fatalism beliefs compared to Indian adults. Vietnamese adults also have a high level of cancer fatalism beliefs. These findings highlight the heterogeneity among Asian American origin groups and emphasize the importance of culturally tailored interventions, specifically targeting those groups with higher levels of fatalism beliefs. Data collection that is disaggregated by Asian origin group should be prioritized to gain a comprehensive understanding of these beliefs and design effective interventions. Citation Format: Milkie Vu, Yenan Zhu, Ryan Suk. Cancer fatalism among Asian American adults by origin group, 2014-2022 [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A074.

Psychotropic Medication Prescribing Across Medical Providers, 2016-2019.

The authors sought to provide updated estimates of the proportion of psychotropic medications prescribed by different medical providers. This pooled cross-sectional study used data from the Medical Expenditure Panel Survey (2016-2019). Nationally representative estimates of the percentages of all psychotropic medications prescribed by each provider type were calculated, and analyses stratified by medication type, insurance type, and age were conducted. Data from 58,547 psychotropic prescriptions reported by 7,693 unique individuals were analyzed. More than 60% of psychotropic medications were prescribed by providers other than psychiatrists (33.5%) or psychologists (2.2%), such as general practitioners, nurse practitioners, and physician assistants. This distribution varied significantly by medication, insurance, and patient age. Most psychotropic medication prescribing occurs in primary care; however, notable differences by medication, insurance, and age were observed, suggesting areas for future research.