Risk Factor Surveillance System Survey Research Articles

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.

Alarming trends in high-risk uterine cancer histologies in Black women in the US: Is obesity responsible? (138)

<b>Objectives:</b> The incidence and mortality of uterine cancer are increasing, particularly for Black women. Although lack of access to care may explain some of these findings, high-risk histological cell types also contribute to the poor prognosis. We analyzed the current trends, projections, and potential socio-behavioral factors responsible for high-risk histologies in Black women in the United States. <b>Methods:</b> Data were obtained from the United States Cancer Statistics (USCS) database and the Behavioral Risk Factors Surveillance System (BRFSS) survey from 2001 to 2017. 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 (non-Hispanic White, Hispanic, non-Hispanic Black, and non-Hispanic Asian/Pacific Islander), were reported. <b>Results:</b> From 2001 to 2017, 778,891 patients were diagnosed with uterine cancer. While uterine cancer incidence increased among all racial/ethnic groups, the rate of increase was 3.6-fold higher in Black women than White women (AAPC: 2.31% vs 0.63%). From 2001 to 2013, white women had the highest incidence of uterine cancer. However, the incidence rates in White and Black women converged in 2014 due to decreasing incidence in White women and increasing incidence in Black women. We then divided uterine cancer histology into low-risk (grade 1 endometrioid) and high-risk cell types (serous, clear cell, carcinosarcoma). By 2017, high-risk types were 2.8-fold higher in Black women than White women (9.11 vs 3.20 per 100,000) and increased at a 1.6-fold higher rate (AAPC: 4.03 vs 2.53). For Black women, low-risk types increased at only 1.30% annually, whereas high-risk histologies rose 4.03% annually. Furthermore, Black women had the lowest incidence of uterine cancer during their premenopausal years but the highest incidence during their postmenopausal years. Using a predictive model with the current rate of increase, we demonstrated that the incidence of high-risk histologies in Black women would be 2.8-fold higher than that of low-risk histologies by the year 2030 (15.2 vs 5.4 per 100,000). Given that the proposed obesity axis explained high-risk histologic type in Black women with breast cancer, we then used the BRFSS data to estimate obesity trends in Black women. Our results showed that the obesity rate was highest in perimenopausal (45-54 years) Black women at 47.3% compared to 30.0% in White women in 2017. <b>Conclusions:</b> Compared to White women, Black women are twice as likely to present with serous, clear cell, and carcinosarcoma compared to low-grade endometrioid uterine cancer with increasing divergence. These findings may only be partially explained by increasing obesity rates. Transdisciplinary studies are warranted to help bridge this disparity with a focus on environmental and genetic risk factors and differential oncogenic pathways.

Obesity-related cancers disproportionately affect women compared to men in the United States (399)

<b>Objectives:</b> To determine the distribution of obesity-related cancers among women in the United States. <b>Methods:</b> Data were obtained from the United States Cancer Statistics 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 (non-Hispanic White, Hispanic, non-Hispanic Black, and non-Hispanic Asian/Pacific Islander) were reported. <b>Results:</b> Between 2001 and 2018, obesity was related to 10,581,122 cancer cases. Although obesity affected more men than women (30.4% vs 28.33%), obesity-related cancers were twice as common in women compared to men (69.2% vs 30.8%). Obesity-related cancers were more common in the South (36.0%) compared to the Northwest (20.6%), West (20.7%), or Midwest (22.7%). Cancers of female-only origin accounted for 42.0% of all obesity-related cancers and 60.6% of obesity-related cancers in women (43.8% post-menopausal breast, 11.5% uterine, 5.3% ovarian). Thyroid cancer accounted for 6.7% of all obesity-related cancers and was three times more common in women compared to men (75.2% female, 24.8% male). While the incidence rates of the breast (AAPC -0.36, p<0.017) and ovarian (AAPC -2.03, p<0.000) cancer decreased in women, uterine and thyroid cancers increased (AAPC 3.07 and 0.71, respectively, p<0.000). <b>Conclusions:</b> Despite similar rates of obesity, obesity-related cancers affect more women than men and are more common in the South. Cancers of female-origin account for nearly two-thirds of obesity- related cancers in women.

Changes in Smoking Cessation–Related Behaviors Among US Adults During the COVID-19 Pandemic

Smoking cessation is an urgent public health priority given that smoking is associated with increased risk of severe COVID-19 outcomes and other diseases. It is unknown how smoking cessation changed nationally during the COVID-19 pandemic. To investigate changes in smoking cessation-related behaviors in the US during the COVID-19 pandemic. This cross-sectional study was conducted using 2011 to 2020 data on 788 008 individuals who had smoked in the past year from the nationally representative Behavioral Risk Factor Surveillance System (BRFSS) survey. Representative retail scanner sales data between January 2017 and July 2021 for 1004 unique nicotine replacement therapy (NRT) universal product codes in 31 US states from NielsenIQ were also used. Calendar year and 4-week sales periods. Changes in annual self-reported prevalence of past-year quit attempts and recent successful cessation before (ie, 2011-2019) and during (ie, 2020) the COVID-19 pandemic and changes in sales volumes in millions of pieces of nicotine gum, lozenge, and patch brands before (1271 four-week sales periods between January 2017 and February 2020) and during (558 four-week sales periods between March 2020 and July 2021) the COVID-19 pandemic were calculated. The 2011 to 2020 pooled BRFSS sample (response rate range, 45.2%-49.9%) included 788 008 respondents (243 061 individuals ages 25-44 years [weighted percentage, 42.5%]; 374 519 men [weighted percentage, 55.7%]). For the first time since 2011, annual past-year quit attempt prevalence decreased between 2019 and 2020, from 65.2% (95% CI, 64.5% to 65.9%) to 63.2% (95% CI, 62.3% to 64.0%), with the largest relative decreases among individuals ages 45 to 64 years (61.4% [95% CI, 60.3% to 62.5%] vs 57.7% [95% CI, 56.3% to 59.2%]), those with 2 or more comorbidities (67.1% [95% CI, 66.0% to 68.2%] to 63.0% [95% CI, 61.6% to 64.4%]), and Black individuals (72.5% [95% CI, 70.3 to 74.6] vs 68.4% [95% CI, 65.3% to 71.3%]). Recent successful cessation remained unchanged during 2019 to 2020. Observed mean (SD) 4-week NRT sales volume in the prepandemic period was 105.6 (66.2) million gum pieces, 51.9 (31.6) million lozenges, and 2.0 (1.1) million patches. Compared with expected sales, observed sales during the COVID-19 pandemic were lower by 13.0% (95% CI, -13.7% to -12.3%) for lozenges, 6.4% (95% CI, -7.3% to -5.5%) for patches, and 1.2% (95% CI, -1.7% to -0.7%) for gum. This study found that serious smoking cessation activity among US adults decreased immediately and remained depressed for more than a year during the COVID-19 pandemic. These findings suggest that smokers experiencing disproportionately negative outcomes during the pandemic should be reengaged and assisted in quit attempts.

The effects of hormonal contraceptive use on sleep patterns in women of reproductive age

PurposeHormonal contraceptives alter hormone levels in women and have been linked to alterations in sleep patterns; however, previous studies yielded inconsistent results and lacked generalizability. This study examines hormonal contraceptive use and its impact on sleep outcomes, including sleep duration and sleep disturbances. MethodsWomen self-reported their sleep patterns and use of contraceptives in the 2017 population-based Behavioral Risk Factor Surveillance System Survey (n=1,970). Participants were categorized by use of hormonal or non-hormonal contraceptives for the purpose of pregnancy prevention. Sleep duration was defined as having met the recommended sleep levels of 7-9 hours per 24 hours. Sleep disturbances were defined as trouble falling asleep, staying asleep, or sleeping too much ≥ 6 days within a 14-day period. Prevalence ratios (PRs) and 95% confidence intervals (CIs) were calculated to examine the association between contraceptive use and each sleep outcome. SAS-callable SUDAAN was used for analyses to account for the complex sampling design. ResultsWomen who used hormonal contraceptives had 6% higher prevalence of sleep disturbances (PR: 1.06, 95% CI: 0.99, 1.14) and 17% lower prevalence of not meeting sleep duration recommendations (PR: 0.83, 95% CI: 0.71, 0.98) compared to those who used non-hormonal contraceptives after adjustment for age. ConclusionThese findings suggest the use of hormonal contraceptives may have negative impacts on sleep disturbances, and positive effects on sleep duration among women using contraceptives for preventing pregnancy. Future studies should be conducted in diverse populations utilizing objective measurements of sleep patterns.

Sexual Orientation and Gender Identity-Related State-Level Policies and Perceived Health Among Lesbian, Gay, Bisexual, and Transgender (LGBT) Older Adults in the United States.

ObjectivesWe examined the associations between state-level policies and the health of lesbian, gay, bisexual, and transgender (LGBT) older adults. Methods: Using data from the 2018-2020 Behavioral Risk Factor Surveillance System surveys, we assessed physical and mental health by the tally of points for enacted LGBT-related policies (Low= <0-49.9% of possible points, High= 50-100% of possible points) in 10,032 sexual minority (i.e., lesbian, gay, and bisexual) and 1,072 transgender (non-sexual minority) adults aged 50 and older from 41 states. Results: Sexual minority adults in low tally states had greater odds of reporting fair or poor general health and 14 or more days of poor physical health in the past 30days. Transgender participants in low tally states also had greater odds of reporting fair or poor general health. Discussion: Lesbian, gay, bisexual, and transgender adults have significantly greater risk of poor health if they live in a state with fewer LGBT anti-discriminatory policies enacted.

Rural Residence and Antihypertensive Medication Use in US Stroke Survivors.

BackgroundRelatively greater increases in hypertension prevalence among US rural residents may contribute to geographic disparities in recurrent stroke. There is limited US information on poststroke antihypertensive medication use by rural/urban residence. We assessed antihypertensive use and lifestyle characteristics for US rural compared with urban stroke survivors and residence‐based trends in use between 2005 and 2019.Methods and ResultsUS stroke survivors with hypertension were identified in the 2005 to 2019 national Behavioral Risk Factor Surveillance System surveys. We ascertained the survey‐weighted prevalence of reported antihypertensive use and lifestyle characteristics (ie, physical activity, diabetes, cholesterol, body mass index, and smoking) among respondents with hypertension in odd years over this period by rural/urban residence. Separate trend analyses were used to detect changes in use over time. Survey‐weighted logistic regression was used to calculate unadjusted and adjusted (sociodemographic and lifestyle factors) odds ratios for antihypertensive use by year. Our study included 82 175 individuals (36.4% rural residents). Lifestyle characteristics were similar between rural and urban residents except for higher smoking prevalence among rural residents. Antihypertensive use was similar between rural and urban stroke survivors in unadjusted and adjusted analyses (>90% in both populations). Trend analyses showed a small but significant increase in antihypertensive use over time among urban (P=0.033) but not rural stroke survivors (P=0.587).ConclusionsOur findings indicate that poststroke antihypertensive use is comparable in rural and urban residents with a reported history of hypertension, but additional work is merited to identify reasons for a trend for increased use of these drugs among urban residents.

BMI moderates the association between adverse childhood experiences and COPD

ObjectivesCigarette smoking and obesity are leading risk factors for chronic obstructive pulmonary disease (COPD). Although studies have established an association between adverse childhood experiences (ACEs) and COPD, few studies have examined whether this association is moderated by cigarette smoking or body mass index (BMI). This cross-sectional study examined the association between ACEs and COPD, and whether cigarette smoking or BMI moderates this association. MethodsData for this study came from the 2019 Behavioral Risk Factor Surveillance System survey. An analytic sample of 75,700 adults aged 18–79 years (50.7% female) were analyzed using binary logistic regression. The outcome variable investigated was self-reported physician-diagnosed COPD, and the main explanatory variable was ACEs. ResultsOf the 75,700 respondents examined, 8.1% had COPD. About one in three (33.6%) respondents had no ACEs, 23.1% had one ACE, and about one in five (20.2%) had four or more ACEs. In the multivariable binary logistic regression, we found that the association between ACEs and COPD differs by BMI status. Controlling for the effects of other factors, the association between ACEs and COPD is strongest for respondents who are obese (AOR = 1.41, 95% CI = 1.04–1.91). ConclusionsThe findings of this study demonstrate that ACEs are associated with COPD later in adulthood, and BMI moderated this association. The findings of this study add to the number of studies demonstrating the adverse impact of ACEs on chronic health outcomes among adults.

Cancer disparities in the context of rurality: risk factors and screening across various U.S. rural classification codes.

Prior cancer research is limited by inconsistencies in defining rurality. The purpose of this study was to describe the prevalence of cancer risk factors and cancer screening behaviors across various county-based rural classification codes, including measures reflecting a continuum, to inform our understanding of cancer disparities according to the extent of rurality. Using an ecological cross-sectional design, we examined differences in cancer risk factors and cancer screening behaviors from the Behavioral Risk Factor Surveillance System and National Health Interview Survey (2008-2013) across rural counties and between rural and urban counties using four rural-urban classification codes for counties and county-equivalents in 2013: U.S. Office of Management and Budget, National Center for Health Statistics, USDA Economic Research Service's rural-urban continuum codes, and Urban Influence Codes. Although a rural-to-urban gradient was not consistently evident across all classification codes, the prevalence of smoking, obesity, physical inactivity, and binge alcohol use increased (all ptrend < 0.03), while colorectal, cervical and breast cancer screening decreased (all ptrend < 0.001) with increasing rurality. Differences in the prevalence of risk factors and screening behaviors across rural areas were greater than differences between rural and urban counties for obesity (2.4% vs. 1.5%), physical activity (2.9% vs. 2.5%), binge alcohol use (3.4% vs. 0.4%), cervical cancer screening (6.8% vs. 4.0%), and colorectal cancer screening (4.4% vs. 3.8%). Rural cancer disparities persist across multiple rural-urban classification codes, with marked variation in cancer risk factors and screening evident within rural regions. Focusing only on a rural-urban dichotomy may not sufficiently capture subpopulations of rural residents at greater risk for cancer and cancer-related mortality.

Association Between Alcohol Intake and Prostate Specific Antigen Screening: Results From a National Behavioral Survey

ObjectiveTo assess the association between self-reported alcohol use and prostate cancer (PCa) screening using the U.S.-based Behavioral Risk Factor Surveillance System (BRFSS) survey. Materials and MethodsA cross-sectional analysis of men aged between 55 and 69 who responded to the PSA screening and alcohol consumption portions of the 2018 BRFSS survey was performed. Alcohol consumption was assessed according with the Centers for Disease Control and Prevention definition of binge and heavy drinking. Rates of PSA screening between binge and non-binge drinkers and among heavy and non-heavy drinkers were compared. A complex weighted multivariable logistic regression model, adjusted for socio-economic covariates and weighted using BRFSS sample weights, was used to test the association between the self-reported alcohol use and the odds of PSA screening. ResultsAmong 57,774 men eligible for PCa screening, there were 8,276 binge drinkers with an unadjusted PSA screening prevalence of 37% versus 40% in the non-binge drinking group (P = .018). Among 3,836 heavy drinkers, the unadjusted PSA screening prevalence was 34% versus 40% in non-heavy drinkers (P < .001). In the multivariable analysis, only heavy drinking status was significantly associated with a lower odds of PSA screening (OR: 0.84, 95% CI: 0.72-0.98, P = .02). ConclusionGiven that alcohol overuse may increase the risk of developing cancer, our finding of lower utilization of PCa screening among heavy drinkers is noteworthy. Efforts to support guideline-concordant cancer screening among heavy drinkers may represent an important strategy to reduce the burden of cancer in these men.

HPR72 Predictors of Food Insecurity in a Sample of Informal Caregivers in Southern States in the United States

Southern US states bear a disproportionate burden of food insecurity (FI). Prevalence and predictors of FI among informal caregivers is not well understood. This study estimated the prevalence and sociodemographic and caregiving related predictors of FI among caregivers in Alabama (AL), Mississippi (MS), Tennessee (TN) and Louisiana (LA). Data from 2015 Behavioral Risk Factor Surveillance System (BRFSS) survey was used. Individuals aged 18 years or higher and residing in AL, MS, TN, and LA were included in the sample.