Risk Factor Surveillance Survey Data Research Articles

Cancer disparities by age: a focus on sexual and gender minorities.

The purpose of this study is to examine the age at which sexual and gender minorities are diagnosed with cancer relative to heterosexual cisgender individuals. We use population-based representative Behavioral Risk Factor Surveillance Survey data with self-reported sexual orientation, gender identity, cancer diagnoses, and the age at diagnosis. We determined the mean age at diagnosis and used logistic regression modeling to obtain odds ratios, reporting significant differences defined as p < 0.05. Separately, we adjusted for race/ethnicity and corrected for underlying differences in the age of survey respondents. Compared to heterosexual cisgender populations, sexual and gender minorities are diagnosed about 4-11years earlier, with bisexual women and transgender individuals reporting the youngest age, 43.9 and 52.1years, respectively. When focusing on select cancer types, lesbian and bisexual women are diagnosed earlier with breast, melanoma, other skin cancers, and leukemia & lymphoma. Gay and bisexual men are diagnosed earlier with colorectal cancers, and transgender individuals earlier with breast, prostate, melanoma, and other skin cancers compared to heterosexual men and women. These findings suggest that sexual and gender minorities experience earlier onset of cancer and many of these age differences remained even after adjustments were made. These findings need to be confirmed in oncology settings that have cancer incidence and sexual orientation and gender identity data and call for greater attention to sexual and gender minorities in cancer research.

Social Risk Factors, Health Insurance Coverage, and Inequities in Access to Care.

Social risk factors are associated with worse access to care. This study measured the prevalence of social risk factors among low-income adults, assessed the relationship between number of social risk factors and access to care, and examined heterogeneity by health insurance type. Using 2022 Behavioral Risk Factor Surveillance Survey data from 39 states, the association between number of SRFs (0, 1, 2-3, 4, or more) and three access to care measures (having a personal doctor, having a routine checkup, and inability to see doctor because of cost) were measured using multivariable linear probability models. The analysis was stratified by health insurance coverage type (private, Medicare, Medicaid, or uninsured) to assess whether effects were differential. Analyses were conducted in 2024. Among 90,208 low-income adults, 46.6% reported at least one SRF. Compared to people who reported no SRFs, those who reported four or more were more likely to report being unable to afford care (28.21 percentage points [PP], p<0.001) and less likely to have a personal doctor (-4.98 PP, p<0.001) or routine checkup in the last two years (-4.29 PP, p<0.001). The magnitude of disparity by number of SRFs in inability to afford care was larger among privately insured and uninsured people compared to those with Medicare or Medicaid coverage. Higher levels of SRFs were associated with worse access to care among low-income adults. Policies that minimize cost-related barriers to care, coupled with care delivery reforms and social policies that address SRFs, may improve access to care.

Influenza Vaccination in Adults in the United States with COPD before and after the COVID-19 Pandemic (2017-2022): A Multi-Year Cross-Sectional Study.

There is limited literature regarding seasonal influenza vaccination (SIV) among those with a history of chronic obstructive pulmonary disease (HCOPD) prior to the COVID-19 pandemic, and no information on the topic assessing the years following the pandemic. This cross-sectional study used the Behavioral Risk Factor Surveillance Survey (BRFSS) data from the years 2017 to 2022 (n = 822,783 adults ages 50-79 years; 50.64% males). The exposure was a HCOPD, and the outcome was SIV within the past year. Weighted and adjusted logistic regression models were conducted overall and by the significant effect modifiers: smoking status, sex, and year. Having an HCOPD significantly increases the weighted adjusted odds (WAO) of SIV when compared to not having an HCOPD overall and by smoking status, sex, and year. For 2017 through 2022, among all current, former, and never smokers with an HCOPD, the WAO of SIV were: 1.36 (1.28, 1.45), 1.35 (1.27, 1.43), and 1.18 (1.09, 1.27), respectively. Among males with an HCOPD who were current, former, and never smokers, the WAO of SIV were: 1.35 (1.23, 1.48), 1.45 (1.33, 1.58), and 1.23 (1.05, 1.44), respectively. Among females with an HCOPD who were current, former, and never smokers, the WAO of SIV were: 1.31 (1.20, 1.43), 1.24 (1.15, 1.35), and 1.13 (1.04, 1.23), respectively. Study findings suggest males had significantly greater WAO ratios of receiving SIV than females in 2020 and 2022, during and after the COVID-19 pandemic. More specifically, males with an HCOPD who were former smokers had significantly greater WAOR of receiving SIV than females in 2020 and 2022. Understanding the potential barriers to SIV receipt by smoking status and sex, especially during a pandemic, and especially for individuals impacted by an HCOPD, is essential for better health interventions in times of a national crisis such as a pandemic. Additionally, SIV receipt is low among those with an HCOPD, and efforts should be made to improve this.

Engagement with Preventive Health Behaviors and Safe Firearm Storage Practices Using the 2017 Behavioral Risk Factor Surveillance System.

"Behavioral bundling" is a theory that explains how some health behaviors reinforce one another. This study aims to investigate the relationship between preventive health behaviors (PHBs) and safe firearm storage. This study used a cross-sectional design using 2017 Behavioral Risk Factor Surveillance Survey data. Survey participants resided in California, Idaho, Kansas, Oregon, Texas, and Utah. There were 12,817 people living in households with a firearm included in this study. We classified individuals' engagement in 5 PHBs: cholesterol screening, influenza immunization, physical activity, primary care, and seatbelt use. We defined safe firearm storage as storing a firearm unloaded, or loaded but locked. Using Poisson regression models, we calculated adjusted prevalence ratios (aPRs) to estimate the association between engagement in the five PHBs with safe firearm storage. Most firearm owners reported safe firearm storage (80.3%). The prevalence of safe firearm storage was 3% higher for each additional PHB engaged in (aPR = 1.03 [1.01, 1.05]). There was a higher prevalence of safe firearm storage among those who always wore a seatbelt while driving or riding in a car compared to those who did not (aPR = 1.12 [1.05, 1.18]). This study found preliminary evidence to suggest that engagement in seatbelt usage may be bundled with safe firearm storage, though we are not able to determine causality.

Disparities in Breast Cancer Screening

Background. Despite the death rates of breast cancer declining in the last two decades, new breast cancer cases have disproportionately affected some marginalized populations such as African American women. Since mammography screening disparities by sexual orientation and gender identity are inconsistent, it is important to understand the patterns of mammography screening to inform public health interventions.&#x0D; Aims. This secondary data analysis study aimed to examine the disparities in mammography screening by sexual orientation and gender identity among females assigned at birth (FAAB) overall and stratified by race/ethnicity in the U.S.&#x0D; Methods. By using 2014, 2016, and 2018 Behavioral Risk Factor Surveillance Survey (BRFSS) data, we conducted adjusted multivariable logistic regression models to estimate the odds of receiving an up-to-date mammography screening in relation to sexual orientation, gender identity, and other correlates among FAAB aged 50-74 years (unweighted N=228,257).&#x0D; Results. Overall, the lifetime and up-to-date prevalence of mammography screening were 96.3% and 76.0% in U.S. FAAB, respectively. Non-Hispanic Black (NHB) participants reported a higher rate of up-to-date mammography screening (84.13%) whereas those who had an income less than $15,000 per year had the lowest (71.31%). Being insured, overweight/obese, and not a current smoker were positively associated with receiving an up-to-date mammography screening across racial and ethnic groups. Besides, being physically active was significant for an up-to-date mammography screening in non-Hispanic White (NHW) and Hispanic participants. Also, Hispanic transgender participants were more likely to have an up-to-date mammography screening than their same-ethnic cisgender counterparts.&#x0D; Contribution to Evidence-Based Care. The findings reveal that the disparities in receiving an up-to-date mammography screening varied by sexual identity, gender identity, and race/ethnicity in FAAB aged 50-74 years. The lower rate of an up-to-date mammography screening was found particularly in Hispanic, bisexual AFAB. Future tailored mammogram programs should integrate physical activity and cultural components for people with multiple minority identities.

Association of Life’s Simple 7 and ideal cardiovascular health in American Indians/Alaska Natives

ObjectiveAmerican Indians and Alaska Natives (AI/ANs) are an understudied population at high risk for cardiovascular diseases (CVDs); little is known about contextual factors contributing to CVDs in AI/ANs. This study...

A secondary data analysis of colorectal cancer screening among males assigned at birth: Differences by sexual orientation and race/ethnicity.

3529 Background: We have limited information on CRC screening disparities in people of color (POC) with sexual minority identity. Methods: We analyzed the Behavioral Risk Factor Surveillance Survey (BRFSS) data of males assigned at birth age 50-75 years for up-to-date CRC screening. Descriptive analyses in demographics, socioeconomics, healthy behaviors, and CRC screening were conducted by race/ethnicity, followed by multivariable regressions to identify predictors of CRC screening stratified by race/ethnicity. Results: About 67.70% of eligible males reported having an up-to-date CRC screening that met the USPSTF guideline, with the highest rate among gay men (74.92%) and the lowest among bisexual men (65.35%; p = 0.0024). Non-Hispanic Whites had the higher rates of receiving CRC screening across all groups (p &lt; 0.010). In the adjusted multivariable logistic models for NH-White males, gay men (1.52, 95% CI: 1.20-1.91), non-current smokers (1.56, 95% CI: 1.44-1.69), being overweight/obese (1.15, 95%CI: 1.07-1.23), and being physically active (1.08, 95%CI: 1.00-1.16) had greater odds of having CRC screening. Similar patterns were not found in Hispanic and non-Hispanic Black males. Gay men (3.88, 95% CI: 1.51-9.98) had greater odds of CRC screening in Hispanics, whereas being a non-current smoker (1.42, 95%CI: 1.13-1.79) was a significant factor in NH-Blacks. Health insurance coverage was a significant factor across all racial/ethnic groups. Conclusions: CRC screening disparities were most pronounced among racial/ethnic minority males. Future work on developing tailored CRC screening programs for racial/ethnic subgroups using an intersectional framework is warranted to elucidate observed heterogeneity across race/ethnicity and sexual orientation.

Risk Factors Associated With Alzheimer Disease and Related Dementias by Sex and Race and Ethnicity in the US

Previous estimates suggested that 1 in 3 cases of Alzheimer disease and related dementia (ADRDs) in the US are associated with modifiable risk factors, the most prominent being physical inactivity, depression, and smoking. However, these estimates do not account for changes in risk factor prevalence over the past decade and do not consider potential differences by sex or race and ethnicity. To update estimates of the proportion of ADRDs in the US that are associated with modifiable risk factors and to assess for differences by sex and race and ethnicity. For this cross-sectional study, risk factor prevalence and communality were obtained from the nationally representative US Behavioral Risk Factor Surveillance Survey data from January 2018 to December 2018, and relative risks for each risk factor were extracted from meta-analyses. Data were analyzed from December 2020 to August 2021. Respondents included 378 615 noninstitutionalized adults older than 18 years. The number before exclusion was 402 410. Approximately 23 795 (~6%) had missing values on at least 1 of the variables of interest. Physical inactivity, current smoking, depression, low education, diabetes, midlife obesity, midlife hypertension, and hearing loss. Individual and combined population-attributable risks (PARs) associated with ADRDs, accounting for nonindependence between risk factors. Among 378 615 individuals, 171 161 (weighted 48.7%) were male, and 134 693 (weighted 21.1%) were 65 years and older. Race and ethnicity data were self-reported and defined by the US Behavioral Risk Factor Surveillance System Data; 6671 participants (weighted 0.9%) were American Indian and Alaska Native, 8043 (weighted 5.1%) were Asian, 29 956 (weighted 11.7%) were Black, 28 042 (weighted 16.0%) were Hispanic (any race), and 294 394 (weighted 64.3%) were White. Approximately 1 in 3 of ADRD cases (36.9%) in the US were associated with 8 modifiable risk factors, the most prominent of which were midlife obesity (17.7%; 95% CI, 17.5-18.0), physical inactivity (11.8%; 95% CI, 11.7-11.9), and low educational attainment (11.7%; 95% CI, 11.5-12.0). Combined PARs were higher in men (35.9%) than women (30.1%) and differed by race and ethnicity: American Indian and Alaska Native individuals, 39%; Asian individuals, 16%; Black individuals, 40%; Hispanic individuals (any race), 34%; and White individuals, 29%. The most prominent modifiable risk factors regardless of sex were midlife obesity for American Indian and Alaska Native individuals, Black individuals, and White individuals; low education for Hispanic individuals; and physical inactivity for Asian individuals. The findings suggest that risk factors associated with ADRDs have changed over the past decade and differ based on sex and race and ethnicity. Alzheimer risk reduction strategies may be more effective if they target higher-risk groups and consider current risk factor profiles.

Intersectionality and cancer survivorship: Sexual orientation and racial/ethnic differences in physical and mental health outcomes among female and male cancer survivors.

Because of concerns about sexual minorities' poor cancer survivorship, this study compared cancer survivors' health outcomes in relation to multiple intersecting social positions, namely gender, sexual orientation, and race/ethnicity. This secondary data analysis used 2014-2019 Behavior Risk Factor Surveillance Survey data. The survey respondents consisted of 40,482 heterosexual and sexual minority men and 69,302 heterosexual and sexual minority women who identified as White, Black, or Hispanic. Logistic regression models compared White, Black, and Hispanic male and female cancer survivors' health status, depression, and health-related quality of life by sexual orientation. Models were adjusted for sociodemographic characteristics and access to care. Mental health findings showed consistency, with sexual minority male and female cancer survivors having 2 to 3 times greater odds of depression and/or poor mental health among White, Black, and Hispanic survivors. Among White women, sexual minorities reported greater odds of fair or poor health, poor physical health, and poor activity days, whereas White sexual minority men showed similar odds in comparison with their heterosexual counterparts. Among Black and Hispanic sexual minority men and women, differences in the odds of fair or poor health, poor physical health, and poor activity days in comparison with their heterosexual counterparts were mostly explained by sociodemographic and access-to-care factors. Physical and mental health outcomes vary in relation to sexual orientation and race/ethnicity among both female and male cancer survivors. Clinicians, researchers, and health care administrators must better understand and address the unique needs of cancer survivors in relation to multiple axes of social inequality to advance cancer equity.

Measuring Structural Racism and Its Association With BMI

Structural racism has attracted increasing interest as an explanation for racial disparities in health, including differences in adiposity. Structural racism has been measured most often with single-indicator proxies (e.g., housing discrimination), which may leave important aspects of structural racism unaccounted for. This paper develops a multi-indicator scale measuring county structural racism in the U.S. and evaluates its association with BMI. County structural racism was estimated with a confirmatory factor model including indicators reflecting education, housing, employment, criminal justice, and health care. Using Behavioral Risk Factor Surveillance Survey data (2011-2012) and a mixed-effects model, individual BMI was regressed on county structural racism, controlling for county characteristics (mean age, percentage black, percentage female, percentage rural, median income, and region). Analysis occurred 2017-2019. The study included 324,572 U.S. adults. A 7-indicator county structural racism model demonstrated acceptable fit. County structural racism was associated with lower BMI. Structural racism and black race exhibited a qualitative interaction with BMI, such that racism was associated with lower BMI in whites and higher BMI in blacks. In a further interaction analysis, county structural racism was associated with larger increases in BMI among black men than black women. County structural racism was associated with reduced BMI for white men and no change for white women. The results confirm structural racism as a latent construct and demonstrate that structural racism can be measured in U.S. counties using publicly available data with methods offering a strong conceptual underpinning and content validity. Further study is necessary to determine whether addressing structural racism may reduce BMI among blacks.

Abstract C004: Collecting evidence to drive research that addresses community cancer needs in Western Washington

Abstract Background: The Fred Hutch/University of Washington Cancer Consortium (Consortium) is a National Cancer Institute-designated comprehensive cancer center located in the Seattle metro area. The Consortium comprises four partnering institutions (Fred Hutchinson Cancer Research Center, University of Washington, Seattle Children's Hospital, and Seattle Cancer Care Alliance [SCCA]) that together address the full spectrum of cancer research and interventions to reduce the burden of cancer among catchment area (CA) residents. The Consortium's CA is thirteen counties in western Washington (WA). In an effort to understand and document ongoing research conducted to address the cancer burden, risk factors, incidence, mortality, and inequities in the CA, we initiated a comprehensive needs assessment. Methods: We conducted a quantitative and qualitative needs assessment from September 2017 to June 2018. Quantitative assessment included secondary data analyses from multiple sources (Seattle-Puget Sound Surveillance, Epidemiology and End Results cancer registry, Behavioral Risk Factor Surveillance Survey data, and WA State Department of Health data). Qualitative assessment included semistructured interviews (n=32) conducted in person and over the telephone with key informants representing county health departments, clinic/health systems, SCCA network sites, and community-based organizations. Interviews included questions about barriers and facilitators to cancer screening, referrals, services, access to care, and cancer inequities. Results: The quantitative data analysis identified the top five cancer incidence sites in the CA as breast, prostate, lung, hematologic malignancies and colorectal; the top five mortality sites in the CA are lung, prostate, breast, hematologic malignancies and colorectal. Comparisons of incidence and mortality for the region revealed several inequities: 1) American Indians and Alaska Natives (AIAN) had the most numerous and severe inequities for incidence and mortality of the top cancers; 2) non-Hispanic Blacks had the most severe mortality for prostate cancer; and 3) outlying rural counties had higher incidence and mortality rates than urban areas. Through the qualitative data analysis, we identified seven major themes that influenced cancer prevention and control, including geography, social determinants of health, financial issues, issues around provider trust and communication, issues with agency partnerships/collaboration, and race/ethnicity. Qualitative interviews suggested opportunities for the Consortium to address barriers that underlie several major cancer inequities in the CA. Conclusion: The Consortium will use the needs assessment as a baseline measure to evaluate future research that addresses the cancer burden in the CA. The Consortium now has information to take an informed approach to engage key stakeholders to collaborate and holistically improve cancer research and outcomes for all CA residents. Citation Format: Katherine J. Briant, Beti Thompson, David R. Doody, Clara Reyes, Stephen M. Schwartz, Peggy A. Hannon, Jason A. Mendoza. Collecting evidence to drive research that addresses community cancer needs in Western Washington [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C004.

COMMON UNDERLYING FACTORS FOR KNOWN MODIFIABLE FALL RISKS

Certain demographics, health conditions, and functional limitations are associated with increased older adult falls. Health conditions and functional limitations are potentially modifiable and may have underlying factors in common. This study’s objective is to understand whether health conditions and functional limitations related to increased fall risk have common underlying factors that could be useful in designing interventions. Factor analysis and multivariate logistic regression were used to analyze 2016 Behavioral Risk Factor Surveillance Survey data for adults aged 65+ years. About half of those who reported difficulty dressing (58%), difficulty running errands alone (53%), difficulty remembering (51%) and depression (48%) reported falling compared to 30% of the general older adult population. Two common factors of cognitive and physical limitations were identified and scales created for each. When controlling for demographic characteristics, both cognitive and physical limitations scales were significantly related to a higher odds of falling (Odds ratios=1.5, 1.4 respectively).

Adults with Housing Insecurity Have Worse Access to Primary and Preventive Care.

Housing insecurity has been linked to high-risk behaviors and chronic disease, although less is known about the pathways leading to poor health. We sought to determine whether housing insecurity is associated with access to preventive and primary care. We conducted weighted univariate, bivariate, and multivariate analyses by using 2011 to 2015 Behavioral Risk factor Surveillance Survey data (N = 228,131 adults). The independent variable was housing insecurity derived from the question on worry about paying rent or mortgage. The outcome measures were health services utilization (no usual source of care, no routine checkup in the past 1 year, and delayed medical care due to cost), self-rated health (number of days reported physical, mental health not good, and poor overall health), and number of chronic diseases (0, 1, 2 or more). The covariates included age, sex, race/ethnicity, income, level of education, marital status, and number of children in the family. We also adjusted for state fixed effects and survey year. We performed χ2 tests and binary logistic regressions on categorical variables and ran t tests and estimated linear regression models on continuous variables. Multinomial logistic regressions were estimated for the number of chronic diseases. Of the 228,131 adults in the study sample, 28,704 adults reported housing insecurity. We found that those with housing insecurity were more likely to forgo routine check-ups and lack usual sources of care. Low-income individuals, minorities, the unmarried, and middle-aged adults were more likely to report housing insecurity. Housing insecurity is associated with worse access to preventive and primary care. Interventions to enhance access for these patients should be developed and studied.

Does Current General Mental Health Status Relate to Current Smoking Status in Pregnant Women?

Purpose Research shows that smoking during pregnancy is related to mental health diagnoses. The purpose of this study was to assess whether current general mental health status is related to current smoking status in pregnant women after controlling for other factors related to both mental health and tobacco use during pregnancy. Methods This cross-sectional analysis used 2017 Behavioral Risk Factor Surveillance Survey (BRFSS) data for 621 pregnant women aged 18-38 from Florida (N=136), Kansas (N=116), Minnesota (N=105), Nebraska (N=90), New York (N=78), and Utah (N=96). Multiple logistic regression analysis was used to assess the relationship between current mental health status and current tobacco use, while controlling for state, depression diagnosis, routine checkup, healthcare plan, age, marital status, ethnicity/race, education level, income level, and employment status. Results Overall, very few participants reported current smoking (6%) and about one-third reported low or moderate mental health status in the past 30 days. Adjusted results indicated that those who reported high mental health status were about 3 times less likely (OR=0.29, 95% CI=0.09, 0.88) to report current smoking status compared to those who reported low mental health status. Conclusions Overall, current mental health status was highly related to current smoking status in pregnant women. Clinicians in obstetrics may expect a very low proportion of pregnant women to report smoking and up to one-third to report low or moderate current general mental health status. Given that current mental health issues and current tobacco use may harm both mother and child, be highly related in pregnant women, and change throughout the pregnancy, pregnant women should be screened automatically for both at each visit.

Urban Supplemental Nutrition Assistance Program - Education (USNAP-Ed) Community Garden Project

As part of our Policy, System and Environmental (PSE) efforts, the aim of the Urban Supplemental Nutrition Assistance Program – Education (USNAP-Ed) Community Gardening Project through the Urban Unit of Alabama Cooperative Extension System at Alabama A&M University, was to improve access and availability of fresh produce and to build self-efficacy of citizens within limited resource communities to take control of their health and make positive changes. Limited resource communities. According to the 2015 Behavior Risk Factor Surveillance Survey (BRFSS) data, 27.6% of Alabamians reported eating vegetables less than one time a day. Community gardens are associated with increased vegetable consumption. USNAP-Ed Community Project Garden sites were identified through participation in USNAP-Ed nutrition classes. USNAP-Ed staff provided nutrition lessons and coordinated garden efforts between the program and the sites. Alabama Cooperative Extension System Horticulture staff provided instruction and assistance establishing gardens, explaining gardening concepts, and monitoring garden development. Crops planted included, cucumbers, collards, tomatoes, onions, green beans, zucchini, squash, corn, carrots, lettuce, peppers, and radish. Harvested produce was used within participant homes, or donated to low income residents in the surrounding area. Six garden sites were established in Madison, Morgan, and Lawrence Counties, with a total of 26 raised bed gardens constructed. A total of 889 pounds of produce was harvested and utilized within the homes of local limited resource families. Sustainability plans were implemented at five sites to continue the use of the garden. The USNAP-Ed Community Garden Project was well received by the communities and improved access to fresh produce. The project will continue in the next grant year.

The built environment, transportation policy, and population health: a comparison of two cities

This preliminary study assesses the relationship between active transportation, the built environment, and population perceived health in two comparable cities in the Southeastern United States at different stages of improving infrastructure for active commuting. Behavioral Risk Factor Surveillance Survey data from 2006 to 2012 were analyzed for Charlotte, NC, and Jacksonville, FL. The annual difference between the percentage of Charlotte respondents rating physical health as good compared to Jacksonville’s increased at a rate of 13% based on an exponential growth regression model (p = 0.02). Supportive urban and transportation policies aimed at facilitating healthy behaviors are associated with healthier communities.

Prevalence of diabetes and associated obesity in Pennsylvania adults, 1995-2010.

IntroductionThis study examined trends in the prevalence and sociodemographic distributions of diabetes and the associations of diabetes with obesity over time in adult Pennsylvanians from 1995 through 2010.MethodsWe used Behavioral Risk Factor Surveillance Survey data collected from 1995 through 2010. Diabetes prevalence was assessed by self-report of physician diagnosis. Obesity was assessed by body mass index computed from self-report of height and weight. State-level data for diabetes and associated obesity prevalence from 1995 through 2010 were collected for each year. Data on sociodemographic factors (age, sex, race, income, education) and 1 known disease risk factor (obesity) were also collected. Logistic regression modeling was used to examine associations between diabetes, sociodemographic factors, and obesity.ResultsDiabetes prevalence in Pennsylvania, which increased from 5.6% in 1995 to 10.5% in 2010, followed national trends but exceeded the national prevalence each year by approximately 0.6 percentage points for 12 of the 16 years. The increase in prevalence was not equal across all socioeconomic groups. Obesity became a more dominant risk factor for diabetes during these 16 years.ConclusionThe burden of diabetes and obesity in Pennsylvania is substantial and increasing. Program managers and policy makers in Pennsylvania should consider these trends when allocating limited resources and designing programs for reducing diabetes-related illness. Other states may consider similar studies to monitor the prevalence of diabetes and determine whether disparities are changing and whether programs and resources should also shift.

A population-based study of edentulism in the US: does depression and rural residency matter after controlling for potential confounders?

BackgroundOral health is an integral component of general health and well-being. While edentulism has been examined in relation to socioeconomic status, rural residency, chronic disease and mental health, no study that we know of has examined edentulism and these factors together. The objective of this study was to determine whether depression and rural residency were significantly associated with partial and full edentulism in US adults after controlling for potential confounders.Methods2006 Behavioral Risk Factor Surveillance Survey (BRFSS) data were analyzed to identify factors associated with increased odds of partial or full edentulism. This year of BRFSS data was chosen for analysis because in this year the standardized and validated Personal Health Questionnaire-8 (PHQ-8) was used to measure current depression. This measure was part of the optional questions BRFSS asks, and in 2006 33 states and/or territories included them in their annual surveillance data collection. Bivariate and logistic regression analyses were performed on weighted BRFSS data.ResultsLogistic regression analysis using either full or partial edentulism as the dependent variable yielded that rural residency or living in a rural locale, low and/or middle socioeconomic status (SES), depression as measured by the PHQ-8, and African American race/ethnicity were all independent risk factors when controlling for these and a number of additional covariates.ConclusionsThis study adds to the epidemiological literature by assessing partial and full edentulism in the US utilizing data from the CDC’s Behavioral Risk Factor Surveillance System (BRFSS). Examining data collected through a large national surveillance system such as BRFSS allows for an analysis that incorporates an array of covariates not available from clinically-based data alone. This study demonstrated that current depression and rural residency are important factors related to partial and full edentulism after controlling for potential confounders.

Health Disparities Among Sexual Minority Women Veterans

Lesbian and bisexual (i.e., sexual minority) identity is more common among women veterans than among male veterans. Unique health issues have been identified among women veterans and among sexual minority women, but little is known about women who are both sexual minorities and veterans. This study aimed to compare demographic and health information from sexual minority women veterans with sexual minority women non-veterans and heterosexual women veterans. Behavioral Risk Factor Surveillance Survey data were pooled from ten U.S. states that elected to ask sexual identity during 2010. The analytic sample was comprised of women who identified both their sexual identity and veteran status (n=1,908). Mental health indicators were frequent mental distress, sleep problems, low social/emotional support, and low satisfaction with life. Health risk indicators included current smoking, overweight, and obesity. Physical health status was defined by three components: disability requiring assistive equipment, >14 days of poor physical health in the past 30 days, and activity limitations. Compared with heterosexual women veterans, sexual minority women veterans had higher odds of mental distress (odds ratio [OR]=3.03, 95% confidence interval [CI]: 1.61-5.70) and smoking (OR=2.31, 95%CI: 1.19-4.48). After adjusting for demographic correlates, sexual minority women veterans had three times the odds of poor physical health (OR=3.01, 95%CI: 1.51-5.99) than their sexual minority non-veteran peers. Results suggest sexual minority women veterans may experience unique health disparities relevant to provision of care in both Veterans Affairs (VA) and non-VA healthcare systems. Future research requires availability of data that include sexual minority status.

Examination of pneumococcal vaccination rates among U.S. adult smokers

Pneumococcal vaccination rates among U.S. adult smokers in rural and nonrural areas were compared to determine the effect of federal vaccination recommendations. Using bivariate and multivariate techniques, 2005 and 2010 Behavioral Risk Factor Surveillance Survey data were analyzed for comparative purposes. The dependent variable for this analysis was receipt of pneumococcal vaccine. The population of interest was U.S. adults age 19-64 years who reported that they currently smoked. Covariates included sex, race and ethnicity, household income, educational attainment, geographic area (rural or nonrural location of last routine medical checkup), having a personal health care provider, having health insurance, deferring medical care because of cost, self-defined health status, and receipt of seasonal influenza vaccination in the past 12 months. Results In 2005, 15.5% of smokers reported that they had ever received a pneumonia vaccine; by 2010, this percentage increased to 20.8%. In 2005, rural adult smokers were more likely to receive a pneumococcal vaccine (odds ratio [OR], 1.357; 95% confidence interval [CI], 1.338-1.377) than their nonrural counterparts. In 2010, rural adult smokers were less likely to receive the vaccine (OR, 0.952; 95% CI, 0.938-0.966). In both years, men were more likely to receive pneumococcal vaccine, as were those with health insurance and a health care provider. Overall, receipt of a seasonal influenza vaccine was the strongest predictor of smokers receiving pneumococcal vaccine. U.S. adult smokers were most likely to receive pneumococcal vaccine if they were men, had health insurance, had a health care provider, and received a seasonal influenza vaccination within the past year.