Risk Factor Surveillance System Survey Research Articles

Insurance Coverage and Forgoing Medical Appointments Because of Cost Among Cancer Survivors After 2016.

The uninsured rate began rising after 2016, which some have attributed to health policies undermining aspects of the Affordable Care Act. Our primary objectives were to assess the changes in insurance coverage and forgoing medical care because of cost in cancer survivors from pre-enactment (2016) through postenactment of those policies (2019) and determine whether there were subgroups that were disproportionately affected. The 2016-2019 Behavioral Risk Factor Surveillance System surveys were queried for 18- to 64-year-old cancer survivors. Survey-weighted logistic regression was used to assess temporal changes in (1) insurance coverage and (2) forgoing medical appointments because of cost in the preceding 12 months. A total of 62,669 cancer survivors were identified. The percentage of insured cancer survivors decreased from 92.4% in 2016 to 90.4% in 2019 (odds ratio for change in insurance coverage or affordability per one-year increase [ORyear], 0.92; 95% CI, 0.86 to 0.98; P = .01), translating to 161,000 fewer cancer survivors in the United States with insurance coverage. There were decreases in employer-sponsored insurance coverage (ORyear, 0.89) but increases in Medicaid coverage (ORyear, 1.17) from 2016 to 2019. Forgoing medical appointments because of cost increased from 17.9% in 2016 to 20.0% in 2019 (ORyear, 1.05; 95% CI, 1.01 to 1.1; P = .025), affecting an estimated 169,000 cancer survivors. The greatest changes were observed among individuals with low income, particularly those residing in nonexpansion states. Between 2016 and 2019, there were 161,000 fewer cancer survivors in the United States with insurance coverage, and 169,000 forwent medical care because of cost.

Relation Between Smoking Status and Subjective Cognitive Decline in Middle Age and Older Adults: A Cross-Sectional Analysis of 2019 Behavioral Risk Factor Surveillance System Data.

Smoking status may influence subjective cognitive decline (SCD); however, few studies have evaluated this association. To assess whether smoking status is associated with SCD among middle age and older adults, and to determine if this association is modified by sex at birth. A cross-sectional analysis was conducted using data from the 2019 Behavioral Risk Factor Surveillance System (BRFSS) survey to analyze the relationship between SCD and smoking status (current, recent former, and remote former). Eligible respondents included participants 45 years of age or older who responded to the SCD and tobacco questions of interest. Survey-weighted Poisson regression models were employed to estimate the crude and adjusted prevalence ratios (cPR/aPR) and corresponding 95% confidence intervals (CI) of the association between smoking status and SCD. A Wald test was computed to determine the significance of the interaction term between smoking status and sex (α= 0.05). There were 136,018 eligible respondents, of which approximately 10% had SCD. There was a graded association between smoking and SCD, with the greatest prevalence of SCD among current smokers (aPR = 1.87; CI: 1.54, 2.28), followed by recent former smokers (aPR = 1.47; 95% CI: 1.02, 2.12), and remote former smokers (aPR = 1.11; 95% CI: 0.93, 1.33) each compared to never smokers. There was no evidence of effect modification by sex (p interaction = 0.73). The consistency of smoking as a risk factor for objective and subjective cognitive decline supports the need for future studies to further the evidence on whether changes to smoking status impacts cognition in middle age.

Examining Participation Disparities in Cancer Clinical Trials.

To examine factors that account for disparities in cancer clinical trial participation. Pooled data from Behavioral Risk Factor Surveillance System surveys between 2010 and 2017. Univariate and binary logistic regression analyses were used to examine the associations between participation in clinical trials and demographic and health characteristics, using SAS® procedures to account for complex sample features. Univariate analyses showed that age, race, income, and self-rated health status were significantly associated with the likelihood of participating in cancer clinical trials. Binary logistic analyses showed that Black respondents who were ever diagnosed with cancer were more likely to participate in cancer clinical trials relative to White counterparts. Respondents aged 50-64 years were more likely to have participated in cancer clinical trials compared to those aged 65 years or older. However, respondents who self-rated their health as excellent or very good were less likely to participate in cancer clinical trials. Involving properly trained nurses and nurse practitioners from diverse backgrounds in cancer clinical trials to inform people with cancer about trials and ways to reduce personal barriers will increase participation from all people, regardless of socioeconomic and demographic characteristics.

Abstract B099: Localized implicit and explicit forms of anti-gay prejudice and area-specific chronic disease prevalence

Abstract Objectives. Ample evidence suggests that prejudice detrimentally affects individual-level health status, but little is known about associations between anti-gay/lesbian prejudice and prevalence for stress-modulated chronic diseases. Moreover, research examining implicit or “automatic” and explicit or “overt” prejudice in relation to the health status of sexual minorities and non-minorities remain scant. Thus, I examined the influence of dual forms of prejudice on chronic disease disparities among gay male and lesbians in relation to straight-identifying individuals. Methods. Using the Behavioral Risk Factor Surveillance System (BRFSS) survey responses collected in 2020 and localized measures of anti-gay prejudice from an online forum, I examined the association between geographic area-specific levels of implicit and explicit anti-gay/lesbian prejudice and prevalence for the following stress-modulated chronic conditions: heart disease, diabetes, stroke, and cancer. The sample included gay/lesbian and straight male and female adults living in 28 U.S. states. Results. Relative to areas with low prejudice, residents living in areas high in prejudice (both forms) reported higher prevalence for diabetes and COPD among sexual minorities. Both forms of prejudice predicted greater number of reported days of poor physical and mental health for gay male and lesbian residents. Among heterosexual residents, implicit prejudice predicted greater prevalence for all diseases and explicit prejudice predicted prevalence for all diseases but cancer. Conclusions. Findings show that both forms of anti-gay prejudice predict chronic disease diagnoses for gay/lesbian and straight residents. Theoretical insight using the minority-stress model and practical implications are discussed. Citation Format: Carlos O. Garrido. Localized implicit and explicit forms of anti-gay prejudice and area-specific chronic disease prevalence [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B099.

The Mouth as a Site of Compound Injustices: A Structural Intersectionality Approach to the Oral Health of Working-Age US Adults.

Knowledge of and practice around health inequities have been limited by scarce investigations on intersecting forms of structural oppression, including the extent to which their effects are more severe among multiply marginalized groups. We addressed these insufficiencies by adopting a structural intersectionality approach to the study of edentulism (i.e., complete tooth loss), the dental equivalent of mortality. While individual information was gathered from approximately 200,000 adult (ages 18-64 years) respondents to the 2010 US Behavioral Risk Factor Surveillance System survey, state-level data for 2000 and 2010 were obtained from a 2021 study by Homan et al. (J Health Soc Behav. 2021;62(3):350-370) and the US Census. These 3 sources provided information on edentulism, race, sex, structural racism, structural sexism, and income inequality, in addition to multiple covariates. Analyses showed that the intersections between structural sexism and state-level income inequality and structural racism were associated with 1.4 (95% confidence interval: 1.1, 1.9) and 1.5 (95% confidence interval: 1.1, 2.2) times' increased odds of complete tooth loss, respectively. The frequency of edentulism was highest among non-Hispanic Black men residing in states with high structural racism, high structural sexism, and high economic inequality. Based on these and other findings, we highlight the importance of a structural intersectionality approach to research and policy related to health inequities in the United States and elsewhere.

Assessment of Uptake Appropriateness of Computed Tomography for Lung Cancer Screening According to Patients Meeting Eligibility Criteria of the US Preventive Services Task Force

Currently, computed tomography (CT) is used for lung cancer screening (LCS) among populations with various levels of compliance to the eligibility criteria from the US Preventive Services Task Force (USPSTF) recommendations and may represent suboptimal allocation of health care resources. To evaluate the appropriateness of CT LCS according to the USPSTF eligibility criteria. This cross-sectional study used the 2019 Behavioral Risk Factor Surveillance System (BRFSS) survey. Participants included individuals who responded to the LCS module administered in 20 states and had valid answers to questions regarding screening and smoking history. Data were analyzed between October 2021 and August 2022. Screening eligibility groups were categorized according to the USPSTF 2013 recommendations, and subgroups of individuals who underwent LCS were analyzed. Main outcomes included LCS among the screening-eligible population and the proportions of the screened populations according to compliance categories established from the USPSTF 2013 and 2021 recommendations. In addition, the association between respondents' characteristics and LCS was evaluated for the subgroup who were screened despite not meeting any of the 3 USPSTF screening criteria: age, pack-year, and years since quitting smoking. A total of 96 097 respondents were identified for the full study cohort, and 2 subgroups were constructed: (1) 3374 respondents who reported having a CT or computerized axial tomography to check for lung cancer and (2) 33 809 respondents who did not meet any screening eligibility criteria. The proportion of participants who were under 50 years old was 53.1%; between 50 and 54, 9.1%; between 55 and 79, 33.8%; and over 80, 4.0%. A total of 51 536 (50.9%) of the participants were female. According to the USPSTF 2013 recommendation, 807 (12.8%) of the screening-eligible population underwent LCS. Among those who were screened, only 807 (20.9%) met all 3 screening eligibility criteria, whereas 538 (20.1%) failed to meet any criteria. Among respondents in subgroup 2, being of older age and having a history of stroke, chronic obstructive pulmonary disease, kidney disease, or diabetes were associated with higher likelihood of LCS. In this cross-sectional study of the BRFSS 2019 survey, the low uptake rate among screening-eligible patients undermined the goal of LCS of early detection. Suboptimal screening patterns could increase health system costs and add financial stress, psychological burden, and physical harms to low-risk patients, while failing to provide high-quality preventive services to individuals at high risk of lung cancer.

Associations Between Positive Childhood Experiences and Adult Smoking and Alcohol Use Behaviors in a Large Statewide Sample.

Childhood experiences are linked to myriad indices of health and wellbeing in adulthood, including substance use behaviors. Increasingly, there has been a paradigm shift in prevention science focused on healthy outcomes of positive experiences. The current study examined associations between retrospective reports of positive childhood experiences and patterns of smoking and alcohol use in adulthood. Data were from the 2019 Montana Behavioral Risk Factor Surveillance System survey (N = 6,495; Mage = 55.9years; 49% male as assigned at birth). Outcomes examined with regard to positive childhood experiences included lifetime smoking (> 100 cigarettes), current smoking status, and past-month alcohol use indices (i.e., total drinks, typical quantity, heavy episodic drinking, and peak drinking occasion). Positive childhood experience scores were inversely associated with both smoking outcomes (AORs = 0.66 and 0.61). Curiously, positive childhood experiences were positively associated with any past-month alcohol use (AOR = 1.12), but among respondents who did use alcohol in the past month, positive childhood experiences were inversely associated with all indices of alcohol use patterns: total drinks (CR = 0.94), drinks per occasion (CR = 0.95), heavy episodic occasions (AOR = 0.91), and peak drinking (AOR = 0.95). Findings generally indicated that positive childhood experiences may be protective against cigarette and high-risk alcohol use behaviors in adulthood. Item-by-item analyses identified specific childhood experiences that may be particularly protective, which may inform prevention efforts and policy (prevention recommendations are discussed below).

Socioeconomic Deprivation, Sleep Duration, and Mental Health during the First Year of the COVID-19 Pandemic.

The coronavirus disease 2019 (COVID-19) has had a rapid and sustained negative impact on sleep and mental health in the United States with disproportionate morbidity and mortality among socioeconomically deprived populations. We used multivariable and logistic regression to evaluate the associations among sleep duration, mental health, and socioeconomic deprivation (social deprivation index) in 14,676 Ohio residents from 1101 zip code tabulation areas from the 2020 Behavioral Risk Factor Surveillance System (BRFSS) survey. Higher socioeconomic deprivation was associated with shorter sleep and poorer mental health after adjusting for covariates (age, sex, race, education, income, and body mass index) in the multivariable linear regression models. Those in the highest socioeconomically deprived areas had 1.6 and 1.5 times higher odds of short sleep (duration < 6 h) and poor mental health (>14 poor mental health days), respectively, in the logistic regression models. Previous researchers have focused on limited socio-environmental factors such as crowding and income. We examined the role of a composite area based measure of socioeconomic deprivation in sleep duration and mental health during the first year of COVID-19. Our results suggest the need for a broader framework to understand the associations among socioeconomic deprivation, sleep duration, and mental health during a catastrophic event.

Predictors of Low-Value PSA Screening in Elderly Men

<h3>Purpose/Objective(s)</h3> The US Preventive Services Task Force (USPSTF) advises against prostate-specific antigen (PSA) testing for prostate cancer in men over 70 and identifies men aged 55 - 69 as the target screening group. The PSA test for prostate cancer is limited by its high false-positive rate and often leads to overdiagnosis of prostate cancer. Together, these can expose patients to anxiety, invasive biopsies, and possible over-treatment. We evaluate the predictors of recent PSA testing in men over 70 using Behavioral Risk Factor Surveillance System (BRFSS) survey data. <h3>Materials/Methods</h3> BRFSS 2020 data from PSA-related questions were analyzed, including time since last PSA test, PSA test reason, and whether a provider discussed the advantages and disadvantages of PSA screening with respondents. Men over 70 who answered PSA-related questions met our study criteria. We defined "recent testing" as having had a PSA test within the past two years. We used weighted multivariable logistic regressions with two-sided significance tests to measure effects of age, insurance status, having a primary care physician (PCP), and having discussion of PSA test risks and benefits with a provider on recent testing. Recent testing rates and percentages of men tested via routine screening vs. prostate-specific evaluations were calculated. <h3>Results</h3> Our cohort included 33,556 men. Recent PSA testing was high in men over 70. Men aged 70-75, 75-80, 80+ had testing rates of 56.3%, 53.4%, and 40.8% respectively. In a multivariable regression model, positive predictors of recent testing in men over 70 included being insured (OR = 1.202, 95% CI 1.195 - 1.21, p < 0.001), having a PCP (OR = 1.459, 95% CI 1.454 - 1.465, p < 0.001), and discussing the advantages of PSA testing with a PCP (OR = 3.507, 95% CI 3.5 - 3.515, p < 0.001). Discussing the disadvantages of PSA testing with a PCP had only a small, negative effect on recent testing in men over 70 (OR = 0.996, 95% CI 0.995 - 0.998, p < 0.001). Among men over 70 who had recent PSA tests, 73.3% reported routine testing as the main reason for their tests. We repeated our analysis with the unweighted survey data and found no significant changes in results. <h3>Conclusion</h3> Despite USPSTF guidelines, men over 70 continue to be screened with PSA at a high rate. Routine testing accounted for the majority of recent PSA tests in men over 70. Having a discussion of the benefits of PSA tests with a provider had the largest effect on recent testing in men over 70, which underscores the role of the provider in positively influencing PSA testing rates. Other related predictors of PSA testing in men over 70 included being insured and having a PCP. These findings suggest changes can be made at the provider-level to increase adherence to guidelines on age-based PSA testing.

Scarier than the flu shot? : The social determinants of shingles and influenza vaccinations among U.S. older adults

BackgroundAlthough more than half of older adults receive the annual influenza vaccine (flu shot), only about one-third have ever been vaccinated for shingles. With this in mind, our study examines how the associations between sociodemographic characteristics, health behaviors, and vaccine uptake differ between these two viruses. In doing so, it also investigates whether the social predictors of shingles vaccination changed after the rollout of a new vaccine in 2017. MethodsData come from the 2017 and 2020 waves of the Behavioral Risk Factor Surveillance System survey, using a subset of older adults aged 60-plus (N = 389,165). We use logistic regression models to test for associations between individual-level characteristics and vaccine uptake. ResultsOne, when compared to Whites, Black respondents had approximately 30 % lower odds of having received the annual influenza vaccine (Odds Ratios [OR] = 0.72 [95 % CI 0.66–0.78] in 2017, and 0.66 [0.60–0.72] in 2020). For the shingles vaccine, these racial differences were starker (OR = 0.53 [0.48–0.59] in 2017, and OR = 0.55 [0.49–0.60] in 2020). Two, self-rated health was negatively associated with having received the influenza vaccine, but showed little relationship with shingles vaccination. Three, men were less likely than women to receive both vaccines in 2020 (OR = 0.88 [0.83–0.94] for influenza, and OR = 0.80 [0.75–0.85] for shingles). Four, older adults who abstained from alcohol were, generally, less likely to receive either vaccine, when compared to both moderate and heavy drinkers. Finally, we found that the release of a new shingles vaccine in 2017 (Shingrix) had little effect on vaccination prevalence or its social determinants. ConclusionThe importance of social groups, health, and health behaviors on vaccination status may be disease-dependent. This study also provides possible guidance to health care providers and health organizations looking to increase vaccine uptake among older adults, which may have more urgency since the arrival of COVID-19.

Cross-sectional Associations of Multiracial Identity with Self-Reported Asthma and Poor Health Among American Indian and Alaska Native Adults.

American Indian and Alaska Native (AI/AN) multiracial subgroups are underrecognized in health outcomes research. We performed a cross-sectional analysis of Behavioral Risk Factor Surveillance System surveys (2013-2019), including adults who self-identified as AI/AN only (single race AI/AN, n = 60,413) or as AI/AN and at least one other race (multiracial AI/AN, (n = 6056)). We used log binomial regression to estimate the survey-weighted prevalence ratios (PR) and 95% confidence intervals (CI) of lifetime asthma, current asthma, and poor self-reported health among multiracial AI/AN adults compared to single race AI/AN adults, adjusting for age, obesity, and smoking status. We then examined whether associations differed by sex and by Latinx identity. Lifetime asthma, current asthma, and poor health were reported by 25%, 18%, and 30% of multiracial AI/AN adults and 18%, 12%, and 28% single race AI/AN adults. Multiracial AI/AN was associated with a higher prevalence of lifetime (PR 1.30, 95% CI 1.18-1.43) and current asthma (PR 1.36, 95% CI 1.21-1.54), but not poor health. Associations did not differ by sex. The association of multiracial identity with current asthma was stronger among AI/AN adults who identified as Latinx (PR 1.77, 95% CI 1.08-2.94) than non-Latinx AI/AN (PR 1.18, 95% CI 1.04-1.33), p-value for interaction 0.03. Multiracial AI/AN adults experience a higher prevalence of lifetime and current asthma compared to single race AI/AN adults. The association between multiracial identity and current asthma is stronger among AI/AN Latinx individuals. The mechanisms for these findings remain under-explored and merit further study.

Heterogeneity in Obesity Prevalence Among Asian American Adults.

Obesity increases the risk for metabolic and cardiovascular disease, and this risk occurs at lower body mass index (BMI) thresholds in Asian adults than in White adults. The degree to which obesity prevalence varies across heterogeneous Asian American subgroups is unclear because most obesity estimates combine all Asian Americans into a single group. To quantify obesity prevalence in Asian American subgroups among U.S. adults using both standard BMI categorizations and categorizations tailored to Asian populations. Cross-sectional. United States, 2013 to 2020. The analytic sample included 2882158 adults aged 18 years or older in the U.S. Behavioral Risk Factor Surveillance System surveys (2013 to 2020). Participants self-identified as non-Hispanic White ([NHW] n = 2547965); non-Hispanic Black ([NHB] n = 263136); or non-Hispanic Asian ([NHA] n = 71057), comprising Asian Indian (n = 13916), Chinese (n = 11686), Filipino (n = 11815), Japanese (n = 12473), Korean (n = 3634), and Vietnamese (n = 2618) Americans. Obesity prevalence adjusted for age and sex calculated using both standard BMI thresholds (≥30 kg/m2) and BMI thresholds modified for Asian adults (≥27.5 kg/m2), based on self-reported height and weight. Adjusted obesity prevalence (by standard categorization) was 11.7% (95% CI, 11.2% to 12.2%) in NHA, 39.7% (CI, 39.4% to 40.1%) in NHB, and 29.4% (CI, 29.3% to 29.5%) in NHW participants; the prevalence was 16.8% (CI, 15.2% to 18.5%) in Filipino, 15.3% (CI, 13.2% to 17.5%) in Japanese, 11.2% (CI, 10.2% to 12.2%) in Asian Indian, 8.5% (CI, 6.8% to 10.5%) in Korean, 6.5% (CI, 5.5% to 7.5%) in Chinese, and 6.3% (CI, 5.1% to 7.8%) in Vietnamese Americans. The prevalence using modified criteria (BMI ≥27.5 kg/m2) was 22.4% (CI, 21.8% to 23.1%) in NHA participants overall and 28.7% (CI, 26.8% to 30.7%) in Filipino, 26.7% (CI, 24.1% to 29.5%) in Japanese, 22.4% (CI, 21.1% to 23.7%) in Asian Indian, 17.4% (CI, 15.2% to 19.8%) in Korean, 13.6% (CI, 11.7% to 15.9%) in Vietnamese, and 13.2% (CI, 12.0% to 14.5%) in Chinese Americans. Body mass index estimates rely on self-reported data. Substantial heterogeneity in obesity prevalence exists among Asian American subgroups in the United States. Future studies and public health efforts should consider this heterogeneity. National Heart, Lung, and Blood Institute.

Omnibus or Ominous immigration laws? Immigration policy and mental health of the Hispanic population.

This study examines the impact of Omnibus Immigration Laws on the mental health of the Hispanic populations in the U.S. We use a Difference-in-Differences framework and data from the Behavioral Risk Factor Surveillance System Survey of Centers for Disease Control and Prevention for the 2000-2016 period that contains information on more than 400 thousand Hispanics residing in the U.S. We find that the most stringent provision, namely, "show me your papers" laws, adversely affects the mental health of Hispanics and contributes to an increase of 12%-16% in the number of unhealthy mental days and an increase of 13%-18% in the probability of having frequent mental distress in the states with "show me your papers" laws. OIL provisions that enforced the use of E-Verify or limited the use of public benefits to unauthorized immigrants did not have any effect on mental health. The study also examines (1) police stops, (2) physical health, insurance, and employment status, (3) co-ethnic density, and (4) immigration enforcement awareness as potential mechanisms that could lead to a deterioration in the mental health of Hispanics. The evidence indicates their vulnerability to strict immigration enforcement. The social and public health cost should be carefully evaluated when formulating and implementing immigration policies.

The relationship between types of physical activity and mental health among U.S. adults

BackgroundPhysical activity is known to have a positive relationship with an individual's mental health and well-being. However, there is not enough data on how different types of physical activity participation relate to mental health. The study aims to examine the relationship between different types of physical activities on mental health status among U.S. adults. MethodsThis study used a secondary data analysis of 316,959 participants from the 2019 Behavioral Risk Factor Surveillance System (BRFSS) survey. Seventy-four different activities were identified and categorized into eight distinct activity types. Proportional odds logistic regression was utilized to calculate crude and adjusted odds ratios between physical activity type and mental health status. ResultsOverall, walking (38.9%) was the most commonly reported physical activity type. Compared to no physical activity, the crude and adjusted odds of experiencing mental health problems were significantly lower for all physical activity types, with adjusted odds ratios from 0.65 to 0.85. Running, sports, and weightlifting had the strongest relationships to better mental health while household tasks had the weakest, though when adjusting for multiple testing there were no significant differences in mental health between different types of physical activity. ConclusionsIndividuals participating in any physical activity have lower odds of experiencing mental health problems during the previous 30 days compared to inactive individuals. Knowing what type of specific physical activity adults commonly participate in and understanding their relationships with mental health can help in physical activity promotion and strategies.

Characteristics of Cancer Survivors Living in Poverty in the United States: Results From the 2020 Behavioral Risk Factor Surveillance System Survey.

There has been increasing concern over the high cost of oncology care and its long-lasting impact on the well-being of cancer survivors. We examined characteristics of impoverished cancer survivors in the United States, including their physical and mental health, using data from the 2020 Behavioral Risk Factor Surveillance System. We used binomial logistic regressions for binary outcome variables, and negative binomial regressions for count variables, to estimate the odds ratios (ORs) and incident rate ratios (IRRs) of the physical, mental, and socioeconomic-related health factors for low-income cancer survivors versus higher-income survivors. We compared the ORs and IRRs for low-income cancer survivors with those of higher income cancer survivors. There was a two-fold increased odds (adjusted OR, 2.33; 95% CI, 1.86 to 2.91) of having fair/poor health for low-income cancer survivors compared with higher-income cancer survivors. There was an almost two-fold increased odds (adjusted OR, 1.97; 95% CI, 1.50 to 2.59) of not being able to see a doctor among low-income cancer survivors, and a 42% lower odds (adjusted OR, 0.58; 95% CI, 0.39 to 0.86) of having health insurance coverage for low-income cancer survivors compared with higher-income survivors. Incidence rate ratios for physical (IRR, 1.52; 95% CI, 1.31 to 1.75) and mental (IRR, 1.53; 95% CI, 1.26 to 1.86) unhealthy days were significantly higher among low-income cancer survivors compared with nonpoor cancer survivors. Strategies are available to ameliorate financial hardship at multiple levels. Implementation of these strategies is urgently needed.

A Comparison of Mental Health and Substance Use Risk Factors between Veteran and Non-Veteran Connected Families in Nebraska, 2016 and 2019

Background: Many studies have found that Veterans and their family members have experienced more mental health disorders and substance use. The purpose of this study compared mental health and substance use risk indicators between U.S. military Veteran and non-Veteran- connected families, so earlier and more targeted interventions can be developed. Methods: The data for this study were based on the 2016 and 2019 Behavioral Risk Factor Surveillance System (BRFSS) survey in Nebraska. The comparisons between Veterans and non-Veteran connected families were made on a set of 9 indicators, including general health status (fair/poor), poor mental health defined as not good on 14 or more of the past 30 days (yes/no), ever told they had depression (yes/no), current cigarette smoker (yes/no), current smokeless tobacco use (yes/no), current e-cigarette use (yes/ no), any tobacco use (yes/no), any alcohol consumption in the past 30 days (yes/no), and binge drank in the past 30 days (yes/no). A Chi-Square test was used to determine significant differences between the indicators. Results: When comparisons were made between Veterans and non-Veterans, some significant differences were found in both 2016 and 2019. For example, in 2016, non-Veterans were more likely to have poor mental health, ever told they had depression, be a current smoker, and engage in binge alcohol drinking. Significant differences were also found between non-Veterans and the spouses and significant others of Veterans for selective risk factors in 2016 and 2019. For example, in both years, spouses and significant others of Veterans were considerably more likely to have greater mental health distress and depression. However, they were less likely to use alcohol or engage in binge drinking. Conclusion: These results indicate that spouses and significant others of Veterans are more likely to suffer from depression and other mental health conditions than Veterans themselves and the non-Veteran population. Organizations serving military families should develop a greater knowledge and understanding of the culture of military families to implement strategies that effectively support Veteran spouses and partners.

High Rates of Multimorbidity Reported Among People of Color Despite Healthy Weight.

Purpose:Weight management is one of the most cited levers for preventing and managing many chronic conditions, particularly those considered to be “lifestyle modifiable.” However, it is unclear how much weight is a driver of illness burden among people of color. This article sought to examine whether people of color are more likely to develop “lifestyle-modifiable” conditions, including diabetes, kidney disease, heart disease, lung disease, and hypertension, both individually and in combination (multimorbidity), in the absence of being obese.Methods:Using data from the 2019 Behavioral Risk Factors Surveillance System survey, we examined the risk of having these conditions among Black, Asian, Native American, Latino/a, and White respondents who reported being “normal weight” (n=86,682), while also controlling for age, gender, smoking history, physical activity, and diet.Results:For each individual condition, White respondents almost always had the lowest risk. On the other hand, Latino/a respondents had the highest rates of diabetes and kidney disease. Native American respondents had the highest rates of heart and lung disease. Black respondents had the highest rates of hypertension. Despite an otherwise healthy weight, Native American, Black, and Latino/a people were 2.5, 2.3, and 1.8 times, respectively, more likely to develop multiple chronic conditions that are typically considered “lifestyle modifiable,” compared to White people.Conclusion:Disease prevention and management guidelines driven by the clinical experience of White people are insufficient for addressing the considerable illness burden that people of color continue to experience.

Adverse Childhood Experiences, Positive Childhood Experiences, and Adult Health

Objective: This study investigates the associations between positive childhood experiences and adult well-being, examining the moderating role of childhood social support in the relationship between adverse childhood experiences (ACEs) and adult health outcomes. Method: Data were from the 2015 Wisconsin Behavioral Risk Factor Surveillance System survey. The sample included 4,849 individuals ages ≥18 years who were asked about their ACEs, childhood social support, and a range of health outcomes. We used logistic regression and subgroup moderation tests to predict health outcomes. Results: Adults with high ACE scores and lower levels of childhood social support had worse health outcomes than those with low ACE scores and higher levels of childhood social support. In addition, adults with lower ACE scores and lower levels of childhood social support had worse health outcomes than the reference group, indicating that inadequate childhood social support itself may contribute to negative health outcomes in later life. Conclusions: Both ACEs and childhood social support were independently associated with adult health problems, and the combination of high levels of ACEs and low childhood social support was the most significant predictor of adverse health outcomes in adulthood, controlling for adult sociodemographic indicators. Building and enhancing supportive relationships in childhood may buffer the negative effects of early adversities on adult well-being.

The role of socioeconomic status in mediating Black-White racial disparities in endometrial cancer incidence and survival (421)

The role of socioeconomic status in mediating Black-White racial disparities in endometrial cancer incidence and survival (421)

The rising rates of uterine cancer in Hispanic women of reproductive age in the United States (444)

Objectives: To determine the rate of uterine cancer in reproductive- age Hispanic women compared to non-Hispanic White women and assess trends in obesity associated with uterine cancer in the United States (US). Methods: Data were obtained from the United States Cancer Statistics (USCS) database and the Behavioral Risk Factors Surveillance System (BRFSS) survey from 2001-2018. Obesity-related cancers as classified by the Centers for Disease Control and Prevention (CDC) were described using SEER*Stata. The average annual percent change (AAPC) was calculated using Joinpoint regression. Incidence rates and demographic factors, including age (divided into 5-10 year age groups), sex, and race, were reported. Reproductive age was defined as women under 50 years, whereas young reproductive age was defined as 18-40 years. Results: Over the 17-year study period, 843,116 patients were diagnosed with uterine cancer, with reproductive-age women accounting for 12.7% of cases. In 2018, Hispanic women aged 35-39 years had the highest incidence of uterine cancer among young reproductive- age women at 13.9 (per 100,000), a rate which was 49% higher than White women (9.3 per 100,000). Incidence increased annually at a rate of 4.0 to 4.5% in Hispanic women versus only 1.5 to 2.3% in White women, a nearly two-fold higher rate in this young cohort (25-39 years old). The intersection of young (35-39 years old) Hispanic women residing in the West had an incidence of 14.93 compared to 6.61 (per 100,000) for White women (1.5-fold higher rate), with corresponding annual rates of increase of 5.24% and 1.48%, respectively. Using a predictive model with the current rate of increase, we demonstrated that the incidence of uterine cancer in young (35-39 year old) Hispanic women in the West will be three times that of White women in the next five years (22.4 vs 7.4 per 100,000 by the year 2026). Using the BRFSS survey, Hispanic women aged 35-44 years reported an obesity rate of 30.1% in the year 2018. In a trend analysis from 2001 to 2018, the rate of obesity in Hispanic women rose by 1 .4% annually. Conclusions: The incidence of uterine cancer is rising rapidly in young reproductive-age Hispanic women compared to White women. These results may have public health implications towards the prevention and early detection of uterine cancer in this high-risk population. Objectives: To determine the rate of uterine cancer in reproductive- age Hispanic women compared to non-Hispanic White women and assess trends in obesity associated with uterine cancer in the United States (US). Methods: Data were obtained from the United States Cancer Statistics (USCS) database and the Behavioral Risk Factors Surveillance System (BRFSS) survey from 2001-2018. Obesity-related cancers as classified by the Centers for Disease Control and Prevention (CDC) were described using SEER*Stata. The average annual percent change (AAPC) was calculated using Joinpoint regression. Incidence rates and demographic factors, including age (divided into 5-10 year age groups), sex, and race, were reported. Reproductive age was defined as women under 50 years, whereas young reproductive age was defined as 18-40 years. Results: Over the 17-year study period, 843,116 patients were diagnosed with uterine cancer, with reproductive-age women accounting for 12.7% of cases. In 2018, Hispanic women aged 35-39 years had the highest incidence of uterine cancer among young reproductive- age women at 13.9 (per 100,000), a rate which was 49% higher than White women (9.3 per 100,000). Incidence increased annually at a rate of 4.0 to 4.5% in Hispanic women versus only 1.5 to 2.3% in White women, a nearly two-fold higher rate in this young cohort (25-39 years old). The intersection of young (35-39 years old) Hispanic women residing in the West had an incidence of 14.93 compared to 6.61 (per 100,000) for White women (1.5-fold higher rate), with corresponding annual rates of increase of 5.24% and 1.48%, respectively. Using a predictive model with the current rate of increase, we demonstrated that the incidence of uterine cancer in young (35-39 year old) Hispanic women in the West will be three times that of White women in the next five years (22.4 vs 7.4 per 100,000 by the year 2026). Using the BRFSS survey, Hispanic women aged 35-44 years reported an obesity rate of 30.1% in the year 2018. In a trend analysis from 2001 to 2018, the rate of obesity in Hispanic women rose by 1 .4% annually. Conclusions: The incidence of uterine cancer is rising rapidly in young reproductive-age Hispanic women compared to White women. These results may have public health implications towards the prevention and early detection of uterine cancer in this high-risk population.