Regular Health Care Provider Research Articles

Associations between Perceived Homophobia, Community Connectedness, and Having a Primary Care Provider among Gay and Bisexual Men

According to the minority stress model and social evaluation theory, stigma increases negative health outcomes in sexual minorities, and those with greater connection to a community appraise their lives with respect to fellow community members. This study was a secondary analysis of data from the online 2010 Social Justice Sexuality Project and examined associations between perceived homophobia, community connectedness, and having a health care provider among 2281 men who have sex with men (MSM). Approximately 37.9% (n = 840) of the participants were African American/Black, and approximately 68.3% (n = 1559) self-identified as gay. Perceived homophobia was associated with lower odds of having a regular health care provider (AOR = 0.89, 95% CI 0.85–0.96). Income was associated with at least two-fold greater odds of having a regular health care provider, but only for incomes at or above $20,000 (AORs 1.43–2.39, ps < .001). Community connectedness partially mediated and suppressed the negative association between perceived homophobia and having a primary care provider in the overall model (AOR = 0.95, 95% CI 0.90–1.00), and mediated approximately 14.1% of the total effect in the mediation model. Facilitating community connectedness for MSM may reduce the negative association between perceived homophobia and having a primary care provider, and community-based interventions that promote community connectedness may increase long-term engagement in healthcare utilization.

Abstract C82: Breast density notification in a racially diverse and immigrant sample of women: Evidence for social disparities in awareness, knowledge, and follow-up

Abstract As mandated by legislation in 31 states, clinical mammographic breast density (MBD) information is currently disclosed to women identified as having heterogeneously or extremely dense breasts on routine mammograms (Breast Imaging-Reporting and Data System [BI-RADS] density categories of C/D, hereafter referred to as high MBD). The New York State legislation, enacted in 2013, informs women about the lower sensitivity of mammography and increased breast cancer risk associated with having dense breasts and advises them to seek risk assessment and additional screening; women with low MBD (BI-RADS density categories of A/B) do not receive density information. The legally mandated MBD information provided to women is ambiguous and written at a high literacy level. Additionally, any follow-up actions on this information taken by women require personal resources, including high educational attainment, health insurance coverage, and access to regular health care provider versed in breast cancer risk assessment and screening guidelines. We investigated the impact of this legislation on women's awareness of MBD, knowledge of its effect on breast cancer risk and detection, and communication with health care providers in a predominately Hispanic and foreign-born sample of 466 women, recruited from a mammography clinic in the Northern Manhattan community of New York City (age range: 40-60 years; 79% Hispanic, 12% African American; 81% foreign-born; 26% less than high school education). Overall 88% of the sample had obtained a prior mammogram since 2013 and 31% had heard about MBD. Awareness of MBD did not differ by risk factors for breast cancer (e.g., family history of breast cancer, breast biopsy, parity-related factors) or psychological factors related to breast cancer screening (breast cancer risk perception and worry). Non-Hispanic white women were significantly more likely to have heard of MBD (81%) than non-Hispanic African American (54%), and Hispanic women (13%). In multivariable logistic regression models, odds of MBD awareness were significantly lower in women who were Hispanic (OR=0.1, 95% CI: 0.04, 0.3 relative to white women), foreign-born (OR=0.3, 95% CI: 0.2, 0.6 relative to U.S.-born), or had lower educational attainment (e.g., OR=0.3, 95% CI: 0.2-0.7 for high school or less vs. college or higher degree). Women with personal high MBD were twice as likely as women with low MBD to be aware of MBD, but adjusting for personal MBD did not substantially alter the associations of race/ethnicity, education, and nativity with MBD awareness. In women who reported awareness of MBD, 47% and 76%, respectively, were able to correctly identify the higher risk and masking potential associated with high MBD, and 31% reported following on MBD information with their health care providers. Racial/ethnic and educational differences in knowledge of MBD impact and health care provider communication were smaller and less consistent. In conclusion, awareness of MBD remains low in women from racial/ethnic minority and lower socioeconomic backgrounds, even in a regularly screened population. These findings underscore the importance of understanding and averting potential unintended disparate consequences of breast density notification. Citation Format: Parisa Tehranifar, Carmen B. Rodriguez, Mariangela Agovino, Karen M. Schmitt. Breast density notification in a racially diverse and immigrant sample of women: Evidence for social disparities in awareness, knowledge, and follow-up [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C82.

Correlates of health information seeking between adults diagnosed with and without cancer.

PurposeTo examine predictors of information seeking behavior among individuals diagnosed with cancer versus those without.MethodsCross-sectional data from the Health Information National Trends Survey 4 Cycles 1–3 (October 2011 to November 2013) were analyzed for 10,774 survey respondents aged ≥18 years. Binary logistic regression was used to examine the effect of socio-demographic and behavioral factors on health information seeking.ResultsCancer diagnosis did not predict health information seeking. However, respondents diagnosed with cancer were more likely to seek health information from a healthcare practitioner. Compared to males, females were more likely to seek health information irrespective of cancer diagnosis. Regardless of cancer diagnosis, those without a regular healthcare provider were less likely to seek health information. Likelihood of seeking health information declined across education strata, and significantly worsened among respondents without high school diplomas irrespective of cancer diagnosis.ConclusionsRespondents sought health information irrespective of cancer diagnosis. However, the source of health information sought differed by cancer diagnosis. Gender, education, and having a regular healthcare provider were predictors of health information seeking. Future health communication interventions targeting cancer patients and the general public should consider these findings for tailored interventions to achieve optimal results.

Well-woman Care Barriers and Facilitators of Low-income Women Obtaining Induced Abortion after the Affordable Care Act.

This study uses the abortion visit as an opportunity to identify women lacking well-woman care (WWC) and explores factors influencing their ability to obtain WWC after implementation of the Affordable Care Act. We conducted semistructured interviews with low-income women presenting for induced abortion who lacked a well-woman visit in more than 12months or a regular health care provider. Dimensions explored included 1) pre-abortion experiences seeking WWC, 2) postabortion plans for obtaining WWC, and 3) perceived barriers and facilitators to obtaining WWC. Interviews were transcribed and analyzed using ATLAS.ti. Thirty-four women completed interviews; three-quarters were insured. Women described interacting psychosocial, interpersonal, and structural barriers hindering WWC use. Psychosocial barriers included negative health care experiences, low self-efficacy, and not prioritizing personal health. Women's caregiver roles were the primary interpersonal barrier. Most prominently, structural challenges, including insurance insecurity, disruptions in patient-provider relationships, and logistical issues, were significant barriers. Perceived facilitators included online insurance procurement, care integration, and social support. Despite most being insured, participants encountered WWC barriers after implementation of the Affordable Care Act. Further work is needed to identify and engage women lacking preventive reproductive health care.

Abstract P157: Examining Differences in Interest in Clinical Trial Participation Between Those With and Without a Previous Diagnosis of Hypertension or Heart Disease

Purpose: Despite the large impact heart disease has on morbidity and mortality, many are unaware of the risk factors and the steps they can take to reduce their own risk. Participation in clinical trials for discovering new approaches for the prevention and treatment of heart disease is important. This study sought to determine interest in participation in clinical trials of those diagnosed with heart disease and hypertension as compared to those without such diagnoses, and to assess associated sociodemographic characteristics of interest in participation Methods: Analyses were conducted using data from the 2014 administration of the National Cancer Institute's Health Information National Trends Survey . HINTS is a nationally-representative survey of the US adult (18+) population. The primary outcome of interest was whether respondents expressed interest in participating in research. Bivariate analyses were conducted initially to explore potential associations between sociodemographic factors and having had a diagnosis of hypertension or heart disease. Multivariate logistic regression was used to assess relationships between sociodemographic factors and outcomes, controlling for relevant sociodemographic characteristics and prior diagnosis of hypertension or heart attack. Weighted analyses were done to obtain population-level estimates. Findings: Of the 3,498 respondents, 1,569 (33.3%,) reported having a prior diagnosis of hypertension; 362 of 3,493 (7.0%,) respondents indicated that they had a previously diagnosed heart condition. Logistic regression showed that younger hypertensive participants had higher odds of being interested in participating in clinical trials as compared to those aged 75 years and older (OR = 3.62, 95% CI = 1.94-6.78). Those with regular care providers had higher odds of being interested in clinical trial participation compared to those without regular providers (OR = 1.51, 95% CI = 1.07-2.11). Likewise, younger participants aged 18-34 reporting heart conditions (OR = 3.58, 95% CI = 1.79-7.16) had higher odds of being interested in clinical trial participation compared to those aged 75 and older. No statistical differences were seen in clinical trial awareness, participation, or interest across race or gender. Conclusions: Participants who have a diagnosis of heart disease or hypertension and report being interested in engaging in clinical trial research are generally younger and have a regular health care provider. Therefore, behavioral intervention efforts should focus on translating clinical trial participation interest to participation in younger adults. Clinical trial recruitment efforts should also focus on unique methods to increase interest and subsequent trial enrollment in older adults and those without regularly provided care.

Factors Affecting Uptake of Cervical Cancer Screening Among African Women in Klang Valley, Malaysia

Introduction:Cervical cancer is a health concern among women worldwide, presently ranking as the second to fourth common cancer type among women in different parts of the world. Human papillomaviruses (HPV) 16 and 18 are the main causative agents of cervical cancer. However, prevention is possible with early and regular cervical cancer screening.Objective:This study aimed to identify the cervical cancer screening practices and factors affecting the screening status of African immigrant women attending selected church services in Klang Valley, Malaysia.Methodology:A cross-sectional study among 320 randomly selected respondents between ages 18-69 was conducted in three different churches with high numbers of African participants. A self-administered questionnaire was distributed among the respondents. To ensure a good understanding, the questionnaire was written and self-explained in English language, because English is the general spoken language among the study population. Three levels of analysis were conducted using SPSS 21, involving descriptive analysis, chi square and multiple logistic regression.Results:The response rate was 98.2%, the majority (68.1%) of the respondents being aged 31-50 years and married. The prevalence of screening among the respondents over the past 3 years was 27.2%. Using a p-value of 0.05 as the significance level, the final model showed that marital status (p=0.004), knowledge (p=0.035), perceived barriers (p=0.003), and having a regular health care provider (p<0.001) were the only significant predicting factors of uptake of cervical screening among African immigrant women in Klang Valley, Malaysia.Conclusion:The findings revealed that the uptake of cervical cancer screening among the African women was very low. Marital status, knowledge, perceived barriers and having a regular health care provider were the predictive factors. Specific awareness programs to increase uptake should be designed and implemented by the relevant authorities.

HPV Vaccine recommendations: does a health care provider’s gender and ethnicity matter to Unvaccinated Latina college women?

ABSTRACTObjectives: There are disparities in the uptake of HPV vaccine among racial/ethnic minority women. The strongest predictor of HPV vaccine uptake among adult women is health care provider (HCP) recommendation; however, it is unclear how issues relating to race/ethnicity may mitigate these recommendations. Research shows that racial/ethnic and gender concordance between a patient and HCP can improve patient satisfaction, access and quality of care. If concordance contributes to improved patient-provider interactions, then it may be a factor in patient decisions regarding HPV vaccination. The objectives of this study were to (1) explore gender and ethnicity HCP preference regarding HPV vaccination among unvaccinated; and (2) understand factors associated with those preferences.Design: Unvaccinated Latina college students (n = 187) completed a survey that assessed HCP preferences, medical mistrust, cultural assimilation and HPV vaccine recommendation. Logistic regression models evaluated associations between above variables with HPV knowledge and preference for a female and/or Latina HCP.Results: Most respondents had health insurance (71%), a regular HCP (64%), were US-born (67%), with foreign-born parents (74%). Thirty-four percent and 18% agreed that they would be more likely to get the HPV vaccine if the recommending HCP was female and Latino, respectively. Latina women reporting higher medical mistrust preferred a HPV vaccine recommendation from a Latino/a provider.Conclusions: Latinas’ preferences regarding gender and ethnicity of their HCPs may affect patient-provider interactions. Increasing diversity and cultural awareness among HCPs, and providing linguistically and culturally-appropriate information may decrease patient-provider mistrust, increase uptake of the HPV vaccine, and decrease persistent cervical cancer disparities.

The effect of health insurance coverage and the doctor-patient relationship on health care utilization in high poverty neighborhoods.

African Americans have higher rates of mortality than whites who are the same age and sex. We hypothesize that in low socioeconomic status neighborhoods, having health insurance coverage and a regular health care provider increases the likelihood of receiving diagnostic tests for cardiovascular disease and diabetes. We use data from a random two-stage cluster sample of 230 adults living in high poverty census tracts to examine the effects of insurance coverage and having a regular doctor on the likelihood receiving diagnostic tests for high cholesterol, high blood sugar, and blood pressure. We find that health insurance coverage increases the odds of having a regular health care provider (p < 0.05) and of receiving the diagnostic tests (p < 0.05). Having a regular doctor mediates the effect of insurance coverage on the likelihood of receiving the tests, especially when the participant can report the physician's name.

Beyond the Individual: The Interdependence of Advance Directive Completion by Older Married Adults.

To determine how individual and spousal demographic and health factors are associated with advance directive (AD) completion by married older adults. Dyadic structural equation modeling using the Actor-Partner Interdependence Model. The 2004 to 2012 waves of the Health and Retirement Study. Community-dwelling heterosexual married couples aged 65 and older (N = 2,243). Structural equation modeling with a probit link function was used to estimate associations between men's and women's age, education, health status, prior hospitalization or outpatient surgery in the past 10 years, regular health care provider, and household net assets and their own and their spouses' probabilities of having an AD. Individual and spousal ages were each positively associated with AD completion for men and women. Those with higher education were more likely to possess ADs. Women's probabilities of having ADs were also positively associated with husbands' education. Men whose wives' were in poor health were less likely to have ADs. Men who were hospitalized or underwent outpatient surgery were more likely to have ADs, as were their wives. Women who had regular sources of health care were more likely to have completed ADs. AD completion by older married adults is associated with both individual and spousal factors. How spouses influence one another's advance care planning differs by gender. Future research should account for the dyadic nature of advance care planning, as should public education efforts and interventions promoting AD completion.

Evolving techniques in text-based medical consultation – Physicians’ long-term experiences at an Ask the doctor service

IntroductionBoth the demands and the options for patients to communicate with health care providers utilizing eHealth solutions are increasing. Some patients, or relatives to patients, want to consult another health care provider than the regular one, merely in text. ObjectiveTo improve text-based medical consultation by learning from long-term experiences. Materials and methodsPhysicians with comprehensive experience of answering free-text medical inquiries at an official health portal in Sweden were interviewed. The interviews were analyzed using a grounded theory approach. ResultsOver time, the interviewed physicians developed strategies on how to formulate the answer to a medical inquiry from a previously unknown inquirer. The answering physicians experienced their primary role as providers of medical information and as mediators between an inquirer and the regular health care provider. Many of the answering physicians experienced a personal development with improved communication skills, also in face-to-face meetings with patients. ConclusionText-based medical consultation is part of an expanding area in eHealth. The development of strategies, guidelines, ethical considerations as well as educational efforts are needed to optimize the skills of asynchronous text-based health consultation.

Self-reported preferences for patient and provider roles in cancer treatment decision-making in the United States

Objective To describe differences in preferred roles in cancer treatment decision-making and identify associated sociodemographic and health-related factors among adults in the United States. Methods We conducted a cross-sectional analysis of nationally representative data from the 2014 Health Information National Trends Survey. Descriptive statistics were calculated and multivariable logistic regression was conducted to examine associations. Results Half (48.3%) of respondents preferred a collaborative role in decision-making under the supposition of a moderate chance of survival; while 53.4% preferred a more active role when the chance of survival was low. Approximately 7%–8% indicated a preference for a passive role in decision-making, for both low and moderate chances of survival. Several predictors of role preference for cancer treatment decision-making emerged, including age, sex, education, race/ethnicity, and having a regular health care provider. At both low and moderate chances of survival, the college educated were less likely to prefer a passive role, whereas Hispanics were two to three times more likely than whites to indicate a preference for a passive role. Conclusion Adults’ role preference for cancer treatment decision-making may be influenced by sociodemographic and health-related factors. Increased awareness of these factors, paired with enhanced patient–provider communication, may assist health care professionals in providing individualized and high-quality, patient-centered cancer care.

Predictors of influenza vaccination in the U.S. among children 9–13 years of age

Background and objectivesU.S. estimates of seasonal influenza (flu) vaccine uptake in 2014–2015 were 62% for 5–12year olds, dropping to 47% for 13–17year olds. The Healthy People 2020 goal for these age groups is 80%. It is important to understand factors associated with influenza vaccination, especially for those ages where rates begin to decline. The objective of this study was to identify factors associated with influenza vaccination acceptance in 9–13year old children. MethodsAn online U.S. survey of mothers of children aged 9–13 assessed children's influenza vaccine uptake in the previous season, healthcare utilization, sociodemographics, and vaccine attitudes. Multivariable logistic regression identified independent predictors of influenza vaccine status. ResultsThere were 2363 respondents (Mean age=38years old). Referent children were 57% female and 66% non-minority race/ethnicity with a mean age of 10.6years. By maternal report, 59% of children had received an influenza vaccine in the previous season. Predictors of influenza vaccine uptake included a recommendation or strong recommendation from a health care provider, seeing a health care provider in the past year, positive attitudes regarding the influenza vaccine, and being a minority race. Child gender, age, insurance coverage, and whether the child had a regular healthcare provider were not associated with influenza vaccine uptake (p=n.s.). ConclusionsThis sample reported overall rates of influenza vaccine uptake similar to national surveillance data, but still lower than national goals. Provider recommendations along with health attitudes and seeing a health care provider were associated with vaccine uptake. Promising interventions may include more directive physician messaging for influenza vaccine uptake in youth, encouraging more regular well-child visits during the adolescent years, and promoting influenza vaccination at alternative sites.

Abstract C62: Receipt of cervical cancer screening among women with access to care and other chronic diseases

Abstract Background and Objectives: Cervical cancer screening can save lives when abnormal cervical lesions and early cancers are detected and treated, but many women are not screened as recommended. Limited or no access to health care is a known barrier to screening; however, in 2012, among women with no cervical cancer screening in the previous 5 years, nearly 70% had health insurance and a regular doctor or health care provider. This study examined the factors related to why women aged 40-65 with access to health care are not being screened for cervical cancer as recommended. Methods: The 2014 Behavioral Risk Factor Surveillance System (BRFSS) survey was used to examine non-financial barriers to cervical cancer screening among women who reported insurance and a personal doctor or health care provider. Female respondents were asked if they had ever had a Pap test and if so, when this test was last performed. This study selected women who were aged 40-65 years, reported having medical insurance, at least one personal doctor or health care provider, no hysterectomy, or were not pregnant at the time of the survey. BRFSS data were weighted using advanced raking techniques. Chi-square testing was done to compare the characteristics of the respondents across screening history as screened versus never or rarely screened (more than 5 years). Results: Of the women analyzed for this study, 9.1% were never or rarely screened for cervical cancer and had access to health care with insurance and with a regular health care provider. When compared to women receiving timely screening, women who were never or rarely screened for cervical cancer had a higher prevalence of ever reporting a chronic disease, including chronic obstructive pulmonary disease (COPD) (6% vs 13.7%), arthritis (31.4% vs 38.1), depression (22% vs 31.4%), or diabetes (9.6% vs 15.4%) (all p &amp;lt; 0.01). Also, a significantly higher proportion of women who were never or rarely screened had more than 1 or 2 chronic diseases when compared to women screened on time (3-4 chronic diseases: 7.9% vs 16.6%, p=0.001). Women screened on time were more likely to have had no chronic disease (47.9%, p=0.001). Conclusion: When we examined factors related to cervical cancer screening among women who reported having health insurance and access to a regular doctor or healthcare provider, a larger proportion of women with multiple chronic diseases reported not receiving the recommended screening for cervical cancer. The results of this study underscore the importance of examining the relationship between having multiple chronic diseases and specific barriers to cervical cancer screening. Additional research is recommended to determine if physicians and other health care providers can effectively balance managing patients' chronic diseases and ensuring that patients receive recommended preventive services. Citation Format: Anatasha C. Crawford, Vicki Benard, Jessica King, Cheryll Thomas. Receipt of cervical cancer screening among women with access to care and other chronic diseases. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C62.

Assessing the Influences on Rural Women’s Reproductive Life Plans: A Cross Sectional Descriptive Study

Purpose: This study explored the influences on rural women’s reproductive life planning (RLP). Methods: Thirty rural, non-pregnant, English-speaking women, age 18-35 years, living in two Northern California counties participated in a cross-sectional descriptive study based on the Health Promotion Model (HPM). Data were collected in a local beauty salon using an iPad and an anonymous on-line survey, which included basic demographic information, reproductive plans, contraceptive use, pregnancy readiness, and usefulness of the survey. Findings: Participants were predominantly single, white, educated, religious, long-term rural residents with health insurance, regular healthcare providers, and a desire to have children in the future. Although most felt they would feel “very happy” or “fairly happy” if they were pregnant now, 64% reported they were not ready or unsure if ready for a pregnancy. Forty seven percent were currently using contraception and 81% reported a history of using birth control. Reasons for discontinuing contraception included side effects (80%), dislike of the method (58%), and/or forgot to use it (32%). Reasons for never having used contraception included a personal health issue and confidentiality concerns. Eighty percent reported religion played some role in of their daily lives. The majority provided positive feedback regarding the understandability and usefulness of the survey. Conclusions: Results support RLP usefulness and acceptability among rural women, consistent with the HPM. Further research is indicated examining the observed discontinuity of sexually active women reporting they do not want to get pregnant, yet are not using contraception; the influence of religious/spiritual beliefs on reproductive planning; and the effectiveness of reproductive life planning in reducing unplanned pregnancies. Nurses, with a focus on person/family-centered health promotion, should serve as leaders in promoting reproductive life planning. Policy implications include instituting culturally-tailored RLP as a reimbursed component of care that is routinely provided by nurses and other health care providers. Keywords: Reproductive life planning, rural, women, Health Promotion Model DOI : http://dx.doi.org/10.14574/ojrnhc.v16i2.398

Effect of gender on psychosocial adjustment of colorectal cancer survivors with ostomy

Stoma can pose extensive challenges for colorectal cancer survivors. Identifying the psychological and social adjustment among them and how it differs by gender will aid in identifying those particularly at risk of having poor adjustment and in planning programs to improve their adjustment. The purpose of this study was to determine the effect of gender on psychosocial adjustment of colorectal cancer survivors with ostomy. A descriptive cross sectional study was carried out in the stoma clinic of B.P. Koirala Memorial Cancer Hospital, Bharatpur, Nepal. A purposive sample of 122 patients with ostomy was taken from the above mentioned setting. Selection criteria included colorectal cancer survivors having ostomy for at least 6 months. Data on socio-demographic and clinical variables were collected. Psychosocial adjustment was measured using Ostomy Adjustment Inventory-23 (OAI-23). A total of 122 patients were included in the study. Mean time since ostomy surgery was 2.53 and 1.98 years for men and women respectively. Both men and women had significant impairment in the psychosocial adjustment, however, men had significantly lower psychosocial adjustment score (37.68±12.96 vs. 43.45±12.81, t=-2.47, P=0.015) at 95% CI as compared to women and they reported more negative emotions. Furthermore, men significantly predicted low acceptance {β=-3.078, P=0.023, ΔR2=0.036, F [4,117] =7.90, P<0.001} and social engagement score {β=-2.501, P<0.001, ΔR2=0.098, F [4,117] =6.03, P<0.001}. Colorectal cancer survivors with ostomy should be monitored for psychosocial concerns in regular basis and health care providers should tailor care based on their need. Approaches of survivorship care and psychosocial interventions in colorectal cancer survivors with ostomy should take into account gender specific concerns and requirements to aid adjustment.

The Role of the Primary Romantic Relationship in HIV Care Engagement Outcomes Among Young HIV-Positive Black Men Who Have Sex with Men.

The primary romantic relationship plays a fundamental role in health maintenance, but little is known about its role in HIV care engagement among young Black men who have sex with men (MSM) living with HIV. We examined how HIV care engagement outcomes (i.e., having a primary healthcare provider, receiving HIV treatment, taking antiretroviral medication, and medication adherence) vary by partnership status (single vs. concordant-positive vs. discordant) in a sample of young Black MSM living with HIV. Results showed mixed findings. Partnership status was significantly associated with HIV care engagement, even after adjusting for individual, social, and structural factors. While partnered men were consistently more likely than their single counterparts to have a regular healthcare provider, to receive recent treatment, and to have ever taken antiretroviral medication, they were less likely to report currently receiving antiretroviral therapy. Moreover, men with a discordant partner reported better adherence compared to men with a concordant or no partner. The association between partnership status and HIV care engagement outcomes was not consistent across the stages of the HIV Care Continuum, highlighting the complexity in how and why young Black men living with HIV engage in HIV healthcare. Given the social context of HIV disease management, more research is needed to explicate underlying mechanisms involved in HIV care and treatment that differ by relational factors for young Black MSM living with HIV.

Cancer screening barriers and facilitators for under and never screened populations: A mixed methods study

BackgroundCancer screening is below targets in Ontario, Canada. Our objective was to identify and quantify the barriers and facilitators for breast, cervical and colorectal cancer screening for under and never screened (UNS) residents living in Ontario between 2011 and 2013. MethodsWe used a multi-phased mixed methods study design. Results from thematic analysis of focus group discussions with health care providers and UNS community members were used to develop an on-line, province-wide, cross-sectional survey to estimate the prevalence of barriers and facilitators for the provincial population. Adjusted prevalence odds ratios and 95% confidence intervals were estimated for UNS compared to regularly screened participants using logistic regression. ResultsFour focus groups were held with health service providers and sixteen with UNS community members. Top barriers and facilitators themed around provider-patient communication, fear and embarrassment, history of physical or sexual abuse, social determinants of health (including low literacy, lack of awareness, and health insurance), symptoms appearing, and family and friends. 3075 participants completed the online survey. Compared to regularly screened participants, UNS had significantly higher odds of reporting: no regular health care provider; not feeling comfortable talking about screening; or the Doctor or Nurse Practitioner not suggesting screening. UNS also had significantly higher odds of reporting the facilitators: the test being less scary/painful or uncomfortable; friend/family insisting on getting screened; starting to have symptoms; or an easier test that could be done at home. ConclusionsInterventions addressing fear through individual, interpersonal and structural facilitators may increase cancer screening.

Community-Based Colorectal Cancer Screening in a Rural Population: Who Returns Fecal Immunochemical Test (FIT) Kits?

To determine the return rate of community-delivered fecal immunochemical test (FIT) kits in a rural population and to identify significant predictors of returning kits. Residents were recruited in 8 rural Kentucky counties to enroll in the study and receive an FIT kit. Of 345 recruited, 82.0% returned an FIT kit from the point of distribution. These participants were compared to the remainder relative to age, sex, marital status, having an annual income below $15,000, not graduating from high school, not having a regular health care provider, not having health care coverage, being a current smoker, indicating current overweight or obese status, and a scale measure of fatalism pertaining to colorectal cancer. Predictors achieving significance at the bivariate level were entered into a stepwise logistic regression model to calculate adjusted OR and 95% CI. The return rate was 82.0%. In adjusted analyses, those indicating an annual income of less than $15,000 were 2.85 times more likely to return their kits (95% CI: 1.56-5.24; P < .001). Also, those not perceiving themselves to be overweight/obese were 1.95 times more likely to return their kits (95% CI: 1.07-3.55; P = .029). An outreach-based colorectal cancer screening program in a rural population may yield high return rates. People with annual incomes below $15,000 and those not having perceptions of being overweight/obese may be particularly likely to return FIT kits.

Implications of social media use on health information technology engagement: Data from HINTS 4cycle 3.

Little is known about the association between Internet/social media use and health information technology (HIT) engagement. This study examines patterns of social media use and HIT engagement in the U.S.A. using data from the 2013 Health Information National Trends Survey (N=3,164). Specifically, predictors of two HIT activities (i.e., communicating with a healthcare provider using the Internet or email and tracking personal health information electronically) are examined. Persons who were females, higher education, non-Hispanic others, having a regular healthcare provider, and ages 35-44 were more likely to participate in HIT activities. After controlling for sociodemographics and health correlates, social media use was significantly associated with HIT engagement. To our knowledge, this is one of the first studies to systematically examine the use and relationships across multiple types of health-related online media.

Predictors of prostate cancer screening using Andersen’s Behavioral Model of Health Services Use

PurposeThe purposes of the study were to examine the prevalence of prostate cancer screening (PCS) in the United States and to identify predictors of PCS guided by Andersen’s Behavioral Model of Health Services Use (ABM). MethodsPCS rates were analyzed in men (aged ≥40y) using 2014 data from the Behavioral Risk Factor Surveillance System. Descriptive analysis was conducted using sampling weights to determine the prevalence of PCS (i.e., had a prostate-specific antigen test). Multiple logistic regression within the framework of ABM was used to identify predictors of PCS. The ABM variables of predisposing (e.g., age), enabling (e.g., health insurance), and need (e.g., comorbidities) comprised the independent variables. ResultsAmong the 131,415 men, 62.4% (N = 82,014) reported that they had a prostate-specific antigen test in the last 2 years. Among predisposing factors, age, education, income, and employment status were significantly associated with undergoing PCS. Informed decision-making process, health care coverage, regular health care provider, and length of time since last routine checkup were significant enabling factors. Health care provider recommendation and previous cancer diagnosis were significant need factors. ConclusionsMost older men in the United States had previously engaged in PCS. Several ABM variables were predictive of PCS and should be considered when developing future strategies to encourage PCS in at-risk men with the recommended life expectancies. Such strategies should also ensure that the decision to undergo PCS is an informed process between patients and their health care providers.