Risk Factor Surveillance System Survey Research Articles

Adverse Childhood Experiences Among Lesbian, Gay, Bisexual, and Queer Veterans

Adverse childhood experiences (ACEs) portend vulnerability to numerous physical and mental health concerns across the lifespan. Separate bodies of work suggest that both lesbian, gay, bisexual, and queer (LGBTQ+) individuals and military veterans are more likely to report ACEs compared to their non-LGBTQ+ and non-veteran counterparts, respectively. Although LGBTQ+ veterans experience health disparities compared to non-LGBTQ+ veterans, prevalence of ACEs among individuals with both LGBTQ+ and veteran identities is yet unknown. Participants were US military veterans (N = 14,461) from 18 states that included Sexual Orientation and Gender Identity and ACEs modules in the 2019 and 2020 Behavioral Risk Factor Surveillance System survey. Multivariable logistic regression was used to determine odds of ACEs reported by LGBTQ+ veterans compared with non-LGBTQ+ veterans. Analyses were conducted in 2023. While accounting for socio-demographic factors, LGBTQ+ veterans were more likely to report living with someone who experienced mental illness (aOR = 2.17, 95%CI, 1.35-3.51); emotional abuse (aOR = 1.58, 95%CI, 1.11-2.25); and sexual abuse (aOR = 2.21, 95%CI, 1.29-3.76) compared to non-LGBTQ+ veterans. With past work indicating that childhood abuse experiences are especially predictive of adverse health in adulthood, our findings suggest that a higher prevalence of ACEs among LGBTQ+ veterans may contribute to health disparities among this population.

Estimates of short sleep duration among US rural and urban women with prediabetes.

Short sleep duration (SSD) (<7 hours/night) is linked with increased risk of prediabetes to diabetes progression. Despite a high diabetes burden in US rural women, existing research does not provide SSD estimates for this population. We used national Behavioral Risk Factor Surveillance System surveys to conduct a cross-sectional study examining SSD estimates for US women with prediabetes by rural/urban residence between 2016-2020. We applied logistic regression models to the BRFSS dataset to ascertain associations between rural/urban residence status and SSD prior to and following adjustment for sociodemographic factors (age, race, education, income, health care coverage, having a personal doctor). Our study included 20,997 women with prediabetes (33.7% rural). SSD prevalence was similar between rural (35.5%, 95% CI: 33.0%-38.0%) and urban women (35.4%, 95% CI: 33.7%-37.1). Rural residence was not associated with SSD among US women with prediabetes prior to adjustment (Odds Ratio: 1.00, 95% CI: 0.87-1.14) or following adjustment for sociodemographic factors (Adjusted Odds Ratio: 1.06, 95% CI: 0.92-1.22). Among women with prediabetes, irrespective of rural/urban residence status, being Black, aged <65 years, and earning <$50,000 was linked with significantly higher odds of having SSD. Despite the finding that SSD estimates among women with prediabetes did not vary by rural/urban residence status, 35% of rural women with prediabetes had SSD. Efforts to reduce diabetes burden in rural areas may benefit from incorporating strategies to improve sleep duration along with other known diabetes risk factors among rural women with prediabetes from certain sociodemographic backgrounds.

US Adults Practicing Healthy Lifestyles Before and During COVID-19: Comparative Analysis of National Surveys.

Practicing healthy lifestyles can reduce the risk to develop noncommunicable diseases and the related mortality. Studies showed that practicing healthy lifestyles could enhance disease-free life expectancy and preserve bodily functions. However, engagement in healthy lifestyle behavior was suboptimal. This study aimed to define individuals' lifestyle characteristics before and during COVID-19 and determine the factors associated with practicing a healthy lifestyle. This cross-sectional study was conducted using data from the 2019 and 2021 Behavioral Risk Factor Surveillance System surveys. US individuals aged ≥18 years were interviewed via phone call. Healthy lifestyles were assessed through corresponding questions regarding the maintenance of optimal body weight, physical activity, daily consumption of at least five portions of fruits and vegetables, current smoking status, and alcohol consumption. Missing data were imputed using a package in the R statistical software. The effects of practicing a healthy lifestyle on cases without missing data and those with imputation were reported. There were 550,607 respondents (272,543 and 278,064 from 2019 and 2021, respectively) included in this analysis. The rates of practicing a healthy lifestyle were 4% (10,955/272,543) and 3.6% (10,139/278,064) in 2019 and 2021, respectively. Although 36.6% (160,629/438,693) of all 2021 respondents had missing data, the results of the logistic regression analysis for cases without missing data and those with imputation were similar. Of the cases with imputation, women (odds ratio [OR] 1.87) residing in urban areas (OR 1.24) with high education levels (OR 1.73) and good or better health status (OR 1.59) were more likely to practice healthier lifestyles than young individuals (OR 0.51-0.67) with a low household income (OR 0.74-0.78) and chronic health conditions (OR 0.48-0.74). A healthy lifestyle should be strongly promoted at the community level. In particular, factors associated with a low rate of practice of healthy lifestyles should be targeted.

State Protection Alignment Index as a Measure of Structural Stigma’s Impact on the Mental Health of Sexual and Gender Minorities

Sexual and gender minority (SGM) populations are vulnerable to health disparities, including worse mental health when compared with cisgender, heterosexual populations. This is in part due to the stigma and discrimination they experience. In this study, we used a novel approach to examine structural-level stigma by determining which categories of statewide law and policy protections for SGM people were associated with mental health outcomes among SGM adults. This was a cross-sectional study using law and policy data compiled by the Human Rights Campaign health data and collected through the Behavioral Risk Factor Surveillance System survey in the United States between January and December of 2019. We applied the weighted quantile sum regression to generate the Protection Alignment Index (PAI) from the 10 SGM categories of laws and policies and evaluated the influence of the PAI on the number of days of poor mental health and a diagnosis of depression. SGM people living in states with a higher SGM PAI, indicating greater protections, had significantly fewer poor mental health days. When the PAI increased one interquartile range (IQR≈0.75), the log of expected poor mental health days significantly decreased −0.04 days (95% CI = −0.08, −0.01;p-value = 0.012). Additionally, the odds of depression was 22% lower (OR = 0.78; 95% CI = 0.62, 0.98;p-value = .033) when the SGM PAI increased one IQR (≈0.77). Findings from this study indicate that whether laws and policies discriminate against or protect SGM people impacts the levels of structural stigma and ultimately mental health. Advocating for more protective laws and policies may be a way to help improve the mental health of SGM populations.

Interactions of Sexual Orientation and Gender Identity with Race/Ethnicity in Prevalence of Lifetime and Current Asthma Diagnosis.

Purpose: The current study explored how sexual orientation and gender identity interact with race/ethnicity to predict self-reported lifetime and current diagnosis of asthma. Methods: Using the 2020 Behavioral Risk Factor Surveillance System survey, we conducted logistic regression analyses, weighted for complex samples, stratified by sexual orientation and gender identity, and controlling for race/ethnicity, age, smoking, population density, and body mass index. Results: Analyses showed that there were significantly higher adjusted odds of lifetime asthma among gay men and bisexual men in comparison to heterosexual men, gay/lesbian women and bisexual women in comparison to heterosexual women, and transgender men in comparison to cisgender individuals. In addition, analyses showed that there were significantly higher odds of current asthma among women with other minority sexual orientations in comparison to heterosexual women. Finally, there was a significant interaction between race/ethnicity and sexual orientation among men. Conclusions: Sexual minority men of color might be particularly vulnerable to chronic asthma. Future research should examine asthma prevalence in sexual and gender minority (SGM) individuals of specific marginalized racial/ethnic groups. Future responses to SGM asthma inequities should include low-cost screening and treatment targeting SGM individuals, and policies improving air quality in urban areas.

Abstract P629: Influenza Vaccine Uptake is Associated With Cholesterol Treatment Adherence: An Analysis of the Behavioral Risk Factor Surveillance System Survey

Introduction: Misinformation, distrust, and other sociocultural factors that influence vaccine uptake may also influence adherence to cholesterol treatment. Hypothesis: Among American adults with hyperlipidemia, individuals who receive influenza vaccination are more likely to report use of cholesterol lowering medication. Methods: We pooled 2017 and 2019 survey data from the Behavioral Risk Factor Surveillance System (BRFSS). Our sample included all respondents aged 40 to 75 years with self-reported high cholesterol. We used logistic regression models adjusted for potential confounders to examine the association between influenza vaccine uptake and use of cholesterol medication. We also evaluated whether the association was different among those with and without established atherosclerotic cardiovascular disease (ASCVD). All analyses accounted for survey weighting. Results: Of 228,338 (weighted = 107,893,277) participants with hyperlipidemia, 51% reported influenza vaccination and 61% reported taking cholesterol medication. Vaccine uptake was associated with cholesterol medication use (OR 2.08, 95% CI 2.00-2.16, p &lt;0.001). Although slightly attenuated, this association persisted after adjustment for socio-demographics, access to care, comorbidities, and adherence to hypertension treatment (OR 1.53, 95% CI 1.42-1.65, p-value &lt;0.001). The association was similar in those with ASCVD (OR 1.63, 95% CI 1.32-2.03, p-value &lt;0.001) and those without ASCVD (OR 1.52, 95% CI 1.40-1.64, p-value &lt;0.001), p-value for interaction = 0.89. Conclusions: Influenza vaccine uptake is associated with cholesterol medication use among American adults with high cholesterol, including those with ASCVD. The sociocultural factors affecting vaccine avoidance, such as misinformation and distrust, merit investigation as potential targets of cardiovascular prevention efforts.

Lung Cancer Screening Among U.S. Military Veterans by Health Status and Race and Ethnicity, 2017–2020: A Cross-Sectional Population-Based Study

Veterans are at high risk for lung cancer and are an important group for lung cancer screening. Previous research suggests that lung cancer screening may not be reaching healthier and/or non-White individuals, who stand to benefit most from lung cancer screening. We sought to test whether lung cancer screening is associated with poor health and/or race and ethnicity among veterans. This cross-sectional, population-based study included veterans eligible for lung cancer screening (aged 55-79 years, ≥30 pack-year smoking history, current smokers or quit within 15 years, no previous lung cancer) in the 2017-2020 Behavioral Risk Factor Surveillance System surveys. Exposures were (1) poor health, defined as fair/poor health status and difficulty walking or climbing stairs, aligning with eligibility criteria for a pivotal lung cancer screening trial, and (2) race/ethnicity. The outcome was a receipt of lung cancer screening. All variables were self-reported. Of 3,376 lung cancer screening-eligible veterans representing an underlying population of 866,000 individuals, 20.3% (95% CI=17.3, 23.6) had poor health, and 13.7% (95% CI=10.6, 17.5) identified as non-White. Poor health was strongly associated with lung cancer screening (adjusted RR=1.64, 95% CI=1.06, 2.27); one third of veterans screened for lung cancer would not qualify for a pivotal lung cancer screening trial in terms of health. Marked racial disparities were observed among veterans: after adjustment, non-White veterans were 67% less likely to report lung cancer screening than White veterans (adjusted RR=0.33, 95% CI=0.11, 0.66). Lung cancer screening is correlated with poorer health and White race/ethnicity among veterans, which may undermine its population-level effectiveness. These results highlight the need to promote lung cancer screening, especially for healthier and/or non-White veterans, an important group of Americans for lung cancer screening.

Housing affordability and mental health in the United States: 2013–2020

This study examined the relationship between housing affordability and mental health of American homeowners and renters during 2013–2020, using fractions of people spending more than 30 percent of their income on housing at the state level as an indicator for housing affordability. State-level housing affordability measures were obtained from the American Community Survey and matched with individual-level data from the Behavioral Risk Factor Surveillance System Survey. By using linear regression models and exploiting variation in housing affordability at the state level for different income groups, this study found that unaffordable housing was associated with poor mental health among renters but not among homeowners. The findings suggest that housing affordability disproportionately affects the mental health of people who rely on renting for their housing needs.

Re-scaling and small area estimation of behavioral risk survey guided by social vulnerability data

BackgroundLocal governments and other public health entities often need population health measures at the county or subcounty level for activities such as resource allocation and targeting public health interventions, among others. Information collected via national surveys alone cannot fill these needs. We propose a novel, two-step method for rescaling health survey data and creating small area estimates (SAEs) of smoking rates using a Behavioral Risk Factor Surveillance System survey administered in 2015 to participants living in Allegheny County, Pennsylvania, USA.MethodsThe first step consisted of a spatial microsimulation to rescale location of survey respondents from zip codes to tracts based on census population distributions by age, sex, race, and education. The rescaling allowed us, in the second step, to utilize available census tract-specific ancillary data on social vulnerability for small area estimation of local health risk using an area-level version of a logistic linear mixed model. To demonstrate this new two-step algorithm, we estimated the ever-smoking rate for the census tracts of Allegheny County.ResultsThe ever-smoking rate was above 70% for two census tracts to the southeast of the city of Pittsburgh. Several tracts in the southern and eastern sections of Pittsburgh also had relatively high (> 65%) ever-smoking rates.ConclusionsThese SAEs may be used in local public health efforts to target interventions and educational resources aimed at reducing cigarette smoking. Further, our new two-step methodology may be extended to small area estimation for other locations and health outcomes.

Preconception health status and associated disparities among rural, Midwestern women in the United States.

Little is known about the preconception/interconception health and behaviors of reproductive-age women in the rural Midwest of the United States. The purpose of this study was to quantify preconception/interconception health status and to identify disparities compared with statewide estimates. In this cross-sectional study, we collected data on 12 health conditions and behaviors that are risk factors for adverse maternal and infant health outcomes from nonpregnant women ages 18-45 years in rural northwestern Ohio. Statistical tests were used to identify associations between selected demographic characteristics and a subset of eight high-priority health measures (smoking, diabetes, heavy alcohol use, folic acid intake, normal weight, sufficient physical activity, and effective contraception use); all but physical activity could be compared with Ohio estimates derived from the Behavioral Risk Factor Surveillance System and Ohio Pregnancy Assessment Survey. Three hundred-fifteen women participated, with 98.4% reporting at least one high-priority risk factor. Statistically significant differences were identified among subpopulations related to smoking, folic acid, normal weight, sufficient physical activity, and effective contraception use. In addition, the proportion of participants reporting hypertension (P < 0.001), smoking (P < 0.001), abnormal weight (P=0.002), and lack of daily folic acid intake (P=0.006) were statistically significantly higher than expected based on statewide estimates. Women in the rural Midwest of the United States are at risk for poor health and pregnancy outcomes. Statewide estimates tracking preconception/interconception health status may obscure variation for at-risk groups, particularly in rural or underserved areas. These findings illustrate the need for interventions to advance preconception/interconception health and improve methods to capture and analyze data for rural women.

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.