Virginia Residents Research Articles

People With Disabilities and Violent Victimization in the Heartland: Results from the First Phase of the West Virginia Community Quality of Life Survey

Studies of violent victimization in rural and remote parts of the U.S. are in short supply and the bulk of those done so far focus mainly on man-to-woman violence in intimate relationships among people without disabilities. There is, indeed, a major need to broaden the focus of rural victimological research to include violence against people with disabilities, which is the main objective of this article. Relying on original exploratory data generated by the first phase of the West Virginia Community Quality of Life Survey (WVCQLS), population estimates of four types of violent victimization are presented: stalking, sexual assault, intimate partner violence, and hate and bias assaults. The results show that a large number of rural West Virginia residents with disabilities experience these forms of victimization. Directions for further empirical and theoretical work are discussed.

Accuracy of self-reported distance to nearest unconventional oil and gas well in Pennsylvania, Ohio, and West Virginia residents and implications for exposure assessment.

Self-reported distances to industrial sources have been used in epidemiology as proxies for exposure to environmental hazards and indicators of awareness and perception of sources. Unconventional oil and gas development (UOG) emits pollutants and has been associated with adverse health outcomes. We compared self-reported distance to the nearest UOG well to the geographic information system-calculated distance for 303 Pennsylvania, Ohio, and West Virginia residents using Cohen's Weighted Kappa. Agreement was low (Kappa = 0.18), and self-reports by Ohioans (39% accuracy) were more accurate than West Virginians (22%) or Pennsylvanians (13%, both p < 0.05). Of the demographic characteristics studied, only educational attainment was related to reporting accuracy; residents with 12-16 years of education were more accurate (31.3% of group) than those with <12 or >16 years (both 16.7%). Understanding differences between objective and subjective measures of UOG proximity could inform studies of perceived exposures or risks and may also be relevant to adverse health effects. IMPACT: We compared objective and self-reported measures of distance to the nearest UOG well for 303 Appalachian Basin residents. We found that residents' self-reported distance to the nearest UOG well had limited agreement with the true calculated distance category. Our results can be used to inform the collection and contextualize the use of self-reported data in communities exposed to UOGD. Self-reported metrics can be used in conjunction with objective assessments and can be informative regarding how potentially exposed populations perceive environmental exposures or risks and could provide insights into awareness of distance-related policies, such as setbacks.

COVID-19 related messaging, beliefs, information sources, and mitigation behaviors in Virginia: a cross-sectional survey in the summer of 2020.

Conflicting messages and misleading information related to the coronavirus (COVID-19) pandemic (SARS-CoV-2) have hindered mitigation efforts. It is important that trust in evidence-based public health information be maintained to effectively continue pandemic mitigation strategies. Officials, researchers, and the public can benefit from exploring how people receive information they believe and trust, and how their beliefs influence their behaviors. To gain insight and inform effective evidence-based public health messaging, we distributed an anonymous online cross-sectional survey from May to July, 2020 to Virginia residents, 18 years of age or older. Participants were surveyed about their perceptions of COVID-19, risk mitigation behaviors, messages and events they felt influenced their beliefs and behaviors, and where they obtained information that they trust. The survey also collected socio-demographic information, including gender, age, race, ethnicity, level of education, income, employment status, occupation, changes in employment due to the pandemic, political affiliation, sexual orientation, and zip code. Analyses included specific focus on the most effective behavioral measures: wearing a face mask and distancing in public. Among 3,488 respondents, systematic differences were observed in information sources that people trust, events that impacted beliefs and behaviors, and how behaviors changed by socio-demographics, political identity, and geography within Virginia. Characteristics significantly associated (p<0.025) with not wearing a mask in public included identifying as non-Hispanic white, male, Republican political identity, younger age, lower income, not trusting national science and health organizations, believing one or more non-evidence-based messages, and residing in Southwest Virginia in logistic regression. Similar, lesser in magnitude correlations, were observed for distancing in public. This study describes how information sources considered trustworthy vary across different populations and identities, and how these differentially correspond to beliefs and behaviors. This study can assist decision makers and the public to improve and effectively target public health messaging related to the ongoing COVID-19 pandemic and future public health challenges in Virginia and similar jurisdictions.

Analysis of Inferior Vena Cava Filter Indications and Retrieval Rates at an Academic Medical Center in Appalachia

Introduction: Inferior vena cava (IVC) filters are placed for prevention of pulmonary embolism in patients with venous thromboembolism (VTE) and a contraindication to anticoagulation. Additional clinical indications for IVC filters, such as pre-operative prophylaxis for VTE and extensive VTE, are controversial and vary across clinical guidelines. Current guidelines recommend that IVC filters be retrieved after resolution of their clinical indication. A common problem is failure to retrieve IVC filters when indicated, resulting in prolonged or indefinite placement of these devices. Failure to remove IVC filters contributes to an increased risk of filter-associated complications such as device migration, embolization to the cardiopulmonary circulation, perforation and increased risk of deep vein thrombosis (DVT). The goal of this study is to identify IVC filter indications and retrieval statistics at our academic medical center in Appalachia. We seek to compare our performance to national averages, identify the reasons for failure of retrieval in our patient population and develop quality improvement initiatives to improve our performance. Methods: An IRB-approved, single-institution, retrospective chart review was conducted for all patients who had an IVC filter placed between January 2020 and December 2022 at West Virginia University Hospital. Patient demographics, comorbidities, placement indications, retrieval statistics and filter-associated complications were obtained from the electronic medical record (EMR). Patients who had a permanent IVC filter placed were excluded from the final analysis. Statistical analysis was performed using Mann-Whitney U and Chi squared tests where appropriate to compare the retrieval and failure of retrieval groups. Results: The study sample (n=450) had a mean age of 65.3±15.4 years and was comprised of 54.2% males and 45.8% females. West Virginia residents comprised 82.4% of the study sample. The most common reported clinical indications for placement included VTE with a contraindication to anticoagulation (62.4%), preoperative prophylaxis for VTE (15.8%), extensive VTE (15.3%), pharmacomechanical thrombectomy (15.0%) or other (3.1%). The rate of IVC filter retrieval was 25.4% (n=114). The most common reasons for failure of retrieval were loss to follow-up (31.8%), other reasons including provider or patient preference (31.5%), patient death (28.3%), clinical indication remains present (5.7%) and unsuccessful retrieval (2.7%). Patients in the failure of retrieval group (n=114) were significantly older (69 vs 61 years, p&amp;lt;0.001) and had a higher frequency of clinical indications for history of VTE with a contraindication to anticoagulation (231 vs 50 patients, p&amp;lt;0.0001) and extensive VTE (49 vs 20 patients, p&amp;lt;0.0001) compared to retrieval group (n=336). There was a nonsignificant trend toward greater frequency of chronic conditions in the failure of retrieval group including cancer history (101 vs 26 patients, p=0.15), heart failure (44 vs 11, p=0.41) and hypercoagulable disease (16 vs 2 patients, p=0.26). Conclusions: Our institution had a lower IVC filter retrieval rate than the estimated average of 34% reported in a systematic review by Angel et al. Patients with comorbid conditions tended to not undergo retrieval, predisposing them to a higher risk of filter-associated complications. A history of VTE with a contraindication to anticoagulation was the most common clinical indication for placement, but the other most common indications are not universally guideline recommended which identified an area of opportunity for multidisciplinary provider education. Patient loss to follow-up is the predominant reason for failure of retrieval at our institution, which is consistent with the healthcare disparity faced by our predominantly rural, Appalachian patient population of travelling long distances to our tertiary center to obtain specialty care. Quality improvement strategies to mitigate this limitation in the context of IVC filter placement through close local follow-up for timely reassessment, retrieval evaluation and removal will be developed.

Donor-derived Transmission of Hepatitis A Virus Following Kidney Transplantation: Clinical Course of Two Cases From One Donor.

In 2018, 2 kidneys and a liver were procured from a deceased donor resident of Kentucky, one of many states that was experiencing an HAV outbreak associated with person-to-person transmission through close contact, primarily among people who reported drug use. Both kidney recipients, residents of Virginia, subsequently developed acute HAV infections. We report the results of an investigation to determine the source of transmission and describe the clinical course of HAV infection in the infected kidney recipients. The liver recipient had evidence of immunity to HAV and did not become infected. The donor and both kidney recipients were found to have a genetically identical strain of HAV using a next-generation sequencing-based cyber molecular assay (Global Hepatitis Outbreak Surveillance Technology), confirming donor-derived HAV infections in kidney recipients. At least 1 kidney recipient experienced delayed development of detectable hepatitis A anti-IgM antibodies. By 383 and 198 d posttransplant, HAV RNA was no longer detectable in stool specimens from the left and right kidney recipients, respectively. Adherence to current guidance for hepatitis A vaccination may prevent future morbidity due to HAV among organ recipients. http://links.lww.com/TXD/A548.

“If We Don’t Listen to Them, We Make Them Lose More than Money:” Exploring Reasons for Underreporting and the Needs of Older Scam Victims

Highly manipulative online and telephone scams committed by strangers target everyone, but older individuals are especially susceptible to being victimized. This study aimed to (1) identify why older individuals decide not to report scams and, in parallel, (2) explore the needs of victims. Thirty-five interviews were conducted with Virginia residents who were 60 years or older in 2021. The interpretive phenomenological analysis of the semi-structured interviews revealed that victims are reluctant to report crimes or ask for help from their family or community because much-needed emotional, educational, and technical help is often inaccessible or inadequate. In particular, we found that family responses tend to intrude on privacy, community responses are not meaningful or are non-existent, police responses are inadequate, and prevention programs are inaccessible and not specified to meet the needs of older age groups. We recommend developing age-appropriate prevention and education programs, by applying the intergenerational group approach, and actively listening to victims’ concerns before deciding what means of help should be applied. Research implications and recommendations are presented.

SARS-CoV-2 vaccine breakthrough infections in Virginia, January 17, 2021 – June 30, 2021

As COVID-19 vaccines moved from the controlled environment of clinical trials to use in real-world settings, it has been important to evaluate vaccine effectiveness. A retrospective cohort study was designed to identify cases of SARS-CoV-2 infection that occurred between January 17-June 30, 2021 in fully vaccinated Virginia residents. Of the fully vaccinated population of Virginia at the end of the study period (N = 4,271,505), 2445 (0.057 %) were reported to have experienced a vaccine breakthrough infection. Of those, 183 (7.5 %) were reported to have been hospitalized for COVID-19 and 53 (2.2 %) died from COVID-19. There were significant differences in vaccine effectiveness over time between both mRNA vaccines and the Janssen vaccine. Increasing age, pre-existing medical conditions, and male sex were associated with severe outcomes (hospitalization or death). Persons at greater risk for severe outcomes should continue to take precautions to prevent SARS-CoV-2 infection, even if fully vaccinated.

The Relationship between Wildlife Recreationists' Familiarity with State Fish and Wildlife Agencies, Recreation Identity, and Future Financial Contributions

AbstractNorth American fish and wildlife management has long been supported by the financial contributions of anglers and hunters to state fish and wildlife agencies; however, stagnation in angling participation and declines in hunting participation threaten the stability of this user‐pay support system. While engaging recreationists beyond those with consumptive interests may assist in addressing limitations of the current user‐pay benefit approach, anecdotal evidence suggests differences in recreationists' familiarity with agencies, and perceived benefits of financial contributions may dissuade certain wildlife recreationists from providing agency support. Using focus groups (n = 83) and a survey (n = 1,016) of Virginia residents, we explored how recreationists' familiarity with an agency differed among three categories of wildlife recreationists (i.e., recreation groups)—consumptive (anglers and hunters), nonconsumptive (birders and other wildlife viewers), and multi‐recreationists (those who participate in both consumptive and nonconsumptive activities)—relative to non‐wildlife recreationists (those who do not participate in fish and wildlife recreation). We further examined whether familiarity with an agency and recreation group influenced the future likelihood of financial contributions across voluntary (not required for access or use of natural resources) and user‐pay (required for access or use of natural resources) funding mechanisms. We found that consumptive recreationists and multi‐recreationists had greater familiarity with the agency than nonconsumptive recreationists. Approximately 40% of nonconsumptive recreationists were likely to support the agency through either user‐pay or voluntary mechanisms, while approximately 80% of consumptive recreationists preferred user‐pay mechanisms. Further, all recreationists expected tangible outcomes from their contributions and transparency about how their contributions would benefit their activities (e.g., newsletters detailing angling access funded by their support). We recommend that agencies build familiarity among wildlife recreationists, especially within their nonconsumptive constituency, and demonstrate how current funding mechanisms benefit and are derived from multiple recreation groups.

Identifying bright spot communities: Socioecological, workforce, and healthcare delivery factors influencing opioid mortality.

There were 50,000 U.S. opioid overdose deaths in 2019. Millions suffer from opioid addiction. Identifying protective factors for low community opioid mortality may have important implications for addressing the opioid epidemic. This study was funded through the Virginia (VA) Department of Medical Assistance Services (DMAS) through a SUPPORT Act Grant. To identify "Bright Spot" communities in Virginia with protective factors associated with reduced opioid mortality and morbidity. Ecologic study. Virginia All Payer Claims Database (APCD), Virginia Department of Health (VDH) statewide medical examiner registry, and American Community Survey (ACS). 2016-2019; 2019 data cited here. APCD includes VA residents with medical claims through commercial, Medicaid, and Medicare coverage. VDH data includes fatal drug overdoses. ACS surveys all VA residents. Primary outcome: fatal opioid overdoses. Secondary outcomes: emergency room visits for overdoses and opioid-related diagnoses, outpatient diagnoses for opioid-related disorder, prescription rate for opioids, and prescription rate for buprenorphine. Opioid mortality was associated with higher rates of community poverty (r=.38, p<.0001) and disability (r=.52, r<.0001). Opioid mortality was associated with inequality, with higher Gini index associated with higher opioid mortality (r=.23, p<.0001). A higher percentage of black residents was associated with increased fatal opioid overdoses (r=.37, p<.0001) and ED visits for overdoses (r=.30, p<.0001). A higher percentage of white residents correlated with increased outpatient visits for opioid use disorder (r=.24, p<.0001) and higher rates of buprenorphine (r=.34, p<.0001) and opioid prescriptions (r=.31, p <.0001). These findings suggest significant racial disparities in opioid outcomes. Communities with a higher percentage of black residents are more likely to have higher opioid mortality and a lower rate of outpatient treatment. This association may be affected by the time period used in the analysis (2015-2019), as nationally there has been an increasing rate of synthetic opioid deaths in Black communities. These measures have been incorporated into a multivariate analysis to identify Bright Spot communities, which will be discussed during the presentation.

Prevalence and Types of Drugs Used Among Hepatitis A Patients During Outbreaks Associated with Person-to-Person Transmission, Kentucky, Michigan, and West Virginia, 2016–2019

BackgroundPeople who use drugs are at increased risk for hepatitis A virus infection. Since 1996, the Advisory Committee on Immunization Practices has recommended hepatitis A vaccination for people who use drugs. Since 2016, the U.S. has experienced widespread hepatitis A outbreaks associated with person-to-person transmission.PurposeTo describe the prevalence of drug use, route of use, and drugs used among hepatitis A outbreak-associated patients.MethodsState outbreak and medical records were reviewed to describe the prevalence, type, and route of drug use among a random sample of 812 adult outbreak-associated hepatitis A patients from Kentucky, Michigan, and West Virginia during 2016–2019. Differences in drug-use status were analyzed by demographic and risk-factor characteristics using the X2 test.ResultsAmong all patients, residents of Kentucky (55.6%), Michigan (51.1%), and West Virginia (60.1%) reported any drug use, respectively. Among patients that reported any drug use, methamphetamine was the most frequently reported drug used in Kentucky (42.3%) and West Virginia (42.1%); however, opioids were the most frequently reported drug used in Michigan (46.8%). Hepatitis A patients with documented drug use were more likely (p<0.05) to be experiencing homelessness/unstable housing, have been currently or recently incarcerated, and be aged 18–39 years compared to those patients without documented drug use.ImplicationsDrug use was prevalent among person-to-person hepatitis A outbreak-associated patients, and more likely among younger patients and patients experiencing homelessness or incarceration. Increased hepatitis A vaccination coverage is critical to prevent similar outbreaks in the future.

Engaging rural communities in cancer prevention and control research: Development and preliminary insights from a community-based research registry.

ObjectiveTo report on the development and preliminary findings of a community‐based cancer registry, including the community‐engaged approach to recruitment, participant profile, and distribution of cancer risk factors by race/ethnicity and geography.MethodsCommunity outreach and engagement best practices were used to recruit a diverse convenience sample of Virginia residents (≥18 years) that oversampled residents living in rural areas, defined as Rural‐Urban Continuum Codes (RUCC) 4–9 and African American (AA)/Black residents. Multiple survey administration methods included electronic (e‐survey) and in‐person survey by community‐based staff.ResultsAt the time of this analysis, 595 participants are enrolled; 73% are rural, 46% are AA/Black. AA/Black participants reported similar education but lower income (p < 0.01) and health literacy (p < 0.01), lower alcohol use (p < 0.001), fewer sedentary behaviors (p = 0.01), but greater BMI (p < 0.05) compared to White participants. Rural residents reported significantly lower household income (p < 0.001) and greater use of Medicaid (p = 0.01) compared to urban participants. Biennial mammography was reported by 82% of women aged 45–74 years old and colonoscopy by 77% of participants ≥50 years old. Tobacco use was reported by 17%; no differences in cancer screening or tobacco use were identified by geography or by race.Conclusion and relevanceCommunity engagement strategies successfully enrolled diverse residents within the cancer service area. AA/Black participants reported fewer cancer risk behaviors, similar educational attainment but lower income and health literacy compared to White respondents. Nuanced examinations of interactions among multilevel factors are needed to understand how individual, community, and institutional factors converge to maintain cancer disparities among AA/Black Virginians. Additional findings indicate a need for tobacco cessation, lung cancer screening, obesity treatment, and prevention initiatives.

Mail Communications and Survey Response: A Test of Social Exchange Versus Pre-Suasion Theory for Improving Response Rates and Data Quality

Abstract Mail communications remain a prominent aspect of survey research, especially due to the increasing adoption of web-push surveys throughout the world. However, there is a lack of research on the effectiveness of comprehensive communication strategies for increasing response rates. This paper tests the influence of two communication theories—social exchange theory and pre-suasion theory—on response rates in a survey of residents of southern West Virginia. Social exchange theory has long been used as a strategy for encouraging response, but the theory of pre-suasion offers a new approach of tailoring and sequencing written and visual communications. We operationalized pre-suasion and social exchange communications techniques in the cover letter and questionnaire, then conducted a 2-by-2 experimental design to identify differences in response and data quality. The results show significant differences in response based on the communications in the letter, but no differences based on the questionnaire. The versions with social exchange letters received a response rate 5.5 percent higher than pre-suasion letters. Further, communication differences had no statistically significant effect on measures of data quality. These findings suggest future avenues for research on broad communication strategies in mail survey materials.

Review: i used to love to dream, by A.D. Carson

Review: <i>i used to love to dream</i>, by A.D. Carson

Effects of Sleep Duration on Falls in a West Virginia Population-Based Study, BRFSS, 2018.

IntroductionWest Virginia is a state in which most counties are rural, as well as a state with multiple health disparities among its population. The purpose of this study was to determine the association of sleep duration and falls for non-institutionalized West Virginia adults, aged 40 years and above, using the National Sleep Foundation’s definition of “may be appropriate” and “not recommended” sleep durations for specific ages.MethodsBehavior Risk Factor Surveillance System (BRFSS) 2018 data concerning West Virginia residents were extracted for sleep duration and number of falls within the previous year. Data were analyzed with Chi square and logistic regression analyses on falls.ResultsThere were 2780 participants, aged 45 years and above. Slightly more than half (51.0%) were female. In adjusted logistic regression analysis, the adjusted odds ratio for falls in participants who did not have the recommended sleep duration was 1.77; 95%CI: 1.38, 2.27; p<0.0001 as compared with participants who did have the recommended sleep duration.ConclusionInadequate sleep duration, based on age, was associated with ≥1 falls within the previous year in a West Virginia Appalachian population.

Rural Populations’ Sources of Cancer Prevention and Health Promotion Information

Purpose: Rural residents are less likely to engage in cancer risk-reduction behaviors than their urban counterparts. Rural cancer disparities may be related to limited access to and comprehension of cancer-related health information. The object of this study was to identify how rural residents access and understand cancer health promotion and prevention information. Sample: Twenty-seven residents of Central Virginia Methods: We used a qualitative design with semi-structured interviews and a focus group (n=27) with rural and non-rural residents living in Central Virginia to accomplish the study aim. Findings: Four themes were identified from the data: 1) non-rural Central Virginia residents seek health information from a variety of electronic sources, 2) rural Central Virginia residents typically seek health care information directly from health care professionals, 3) residents throughout Central Virginia encounter confusing health care information, and 4) rural residents report incorrect cancer-related information. Conclusions: Lack of internet access coupled with healthcare shortages may limit the ability of rural residents to contextualize and verify inaccurate health information. Nurses serving a rural population should consider assessing each rural patient’s internet access and disseminating printed cancer health promotion materials to rural clients without internet access.

Health information source use and trust among a vulnerable rural disparities population.

Because rural residents, particularly those near mining sites, are susceptible to numerous environmental health hazards, it is important to gain deeper insights into their use and trust of health information, which they may employ to help recognize symptoms, learn ways to reduce exposure, or find health care. We surveyed residents (N = 101) of rural Kentucky, Virginia, and West Virginia to assess predictors of health information source use and trust. A project manager administered face-to-face paper and pencil questionnaires assessing demographics, health status, smoking behavior, and health information use and source trust. Bivariate correlations and ordinary least squares regressions were used to analyze the data. The data suggest that rural individuals frequently use nurses, doctors, and websites to seek health information, whereas traditional media are often not their preferred channel for health information. Media sources were not found as trustworthy as interpersonal and medical health information sources. While only 13.0% of individuals in the sample said they ever turned to county or state health departments for health information, these sources were trusted more than any media source and more than friends. Moreover, living closer to active mining sites-meaning these individuals are at a higher risk of environmental health hazards-predicted even less use of traditional media and greater trust in peer sources. Not all sources of health information are equally used or trusted by individuals from a rural disparities population. The findings have implications for health campaign message dissemination and intervention designs targeting individuals in rural Appalachia.

Abstract PO-023: The Virginia Living Well Research and Registry: A community registry to assess cancer screening and lifestyle behaviors among rural Virginia residents

Abstract Background: Rural counties in Virginia have significantly higher overall cancer mortality compared to the state. Virginia is one of a few states that has both breast and colorectal cancer hotspots, driven primarily by mortality rates among African Americans. The Virginia Living Well Research and Registry (VALW), a community registry, was developed in collaboration with community partners to collect critical patient reported outcomes, including cancer protective and risk behaviors that can be tracked longitudinally. We assessed participation in cancer screening and five cancer protective behaviors, with comparison by geographical residence and race. Method: In-person and electronic recruitment by community-based staff enrolled adults (18+ years) living in Virginia, focusing on predominantly rural counties. Surveys were completed in-person, by phone or online. Questions included cancer screening (breast, cervical, colorectal), five cancer protective behaviors (physical activity, sleep, alcohol, BMI, smoking status) and demographics. Rural residence was defined using RUCC codes and calculated from mailing addresses. Results: To date, 586 participants are enrolled; 74% are rural (RUCC 4-9), 47% are Black/African American and 70% identify as female. Rural residents reported significantly lower household income (Χ2=25[1]:p&amp;lt; .000), greater use of Medicare (Χ2=4.5[1]:p=.034) and lower (pre-COVID) unemployment (Χ2=7.1[1]:p=.008) compared to urban participants. White participants reported significantly more alcohol use (Χ2=5.6[1]:p=.003), greater sleep disturbance (Χ2=5.6[1]:p=.018) and lower BMI(Χ2=33.4[1]:p&amp;lt;.000) compared to Black participants. Screening rates among those eligible were 82% biennial mammography, 72.3% pap (every 3yr.), 11% annual FIT tests and 77% colonoscopy. 18% reported current tobacco use. No differences in cancer screening, smoking or physical activity were identified by race or rural residence. Only 26% engaged in 4/5 or 5/5 of the assessed cancer protective behaviors. Conclusion: In this geographically and racially diverse sample, engagement in cancer screening was high with no identified racial or geographical disparities, reflecting in part, our long-term community engagement and strong community partnerships. Overall engagement in multiple cancer protective behaviors was low, while tobacco use was higher than the national rate. In addition to screening promotion, cancer prevention efforts in rural communities could leverage successful approaches used to promote screening to also address modifiable lifestyle factors. Finally, the geographical and racial diversity of this sample is strength. Citation Format: Maria D. Thomson, A. Williams, M.A. Preston, A.L. Sutton, V.B. Sheppard. The Virginia Living Well Research and Registry: A community registry to assess cancer screening and lifestyle behaviors among rural Virginia residents [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-023.

A descriptive analysis of outpatient antibiotic use for urinary tract infections in Virginia.

Background: Data regarding outpatient antibiotic prescribing for urinary tract infections (UTIs) are limited, and they have never been formally summarized in Virginia. Objective: We describe outpatient antibiotic prescribing trends for UTIs based on gender, age, geographic region, insurance payer and International Classification of Disease, Tenth Revision (ICD-10) codes in Virginia. Methods: We used the Virginia All-Payer Claims Database (APCD), administered by Virginia Health Information (VHI), which holds data for Medicare, Medicaid, and private insurance. The study cohort included Virginia residents who had a primary diagnosis of UTI, had an antibiotic claim 0–3 days after the date of the diagnosis and who were seen in an outpatient facility in Virginia between January 1, 2016, and December 31, 2016. A diagnosis of UTI was categorized as cystitis, urethritis or pyelonephritis and was defined using the following ICD-10 codes: N30.0, N30.00, N30.01, N30.9, N30.90, N30.91, N39.0, N34.1, N34.2, and N10. The following antibiotics were prescribed: aminoglycosides, sulfamethoxazole/trimethoprim (TMP-SMX), cephalosporins, fluoroquinolones, macrolides, penicillins, tetracyclines, or nitrofurantoin. Patients were categorized based on gender, age, location, insurance payer and UTI type. We used χ2 and Cochran-Mantel-Haenszel testing. Analyses were performed in SAS version 9.4 software (SAS Institute, Cary, NC). Results: In total, 15,580 patients were included in this study. Prescriptions for antibiotics by drug class differed significantly by gender (P < .0001), age (P < .0001), geographic region (P < .0001), insurance payer (P < .0001), and UTI type (P < .0001). Cephalosporins were prescribed more often to women (32.48%, 4,173 of 12,846) than to men (26.26%, 718 of 2,734), and fluoroquinolones were prescribed more often to men (53.88%, 1,473 of 2,734) than to women (47.91%, 6,155 of 12,846). Although cephalosporins were prescribed most frequently (42.58%, 557 of 1,308) in northern Virginia, fluoroquinolones were prescribed the most in eastern Virginia (50.76%, 1677 of 3,304). Patients with commercial health insurance, Medicaid, and Medicare were prescribed fluoroquinolones (39.31%, 1,149 of 2,923), cephalosporins (56.33%, 1,326 of 2,354), and fluoroquinolones (57.36%, 5,910 of 10,303) most frequently, respectively. Conclusions: Antibiotic prescribing trends for UTIs varied by gender, age, geographic region, payer status and UTI type in the state of Virginia. These data will inform future statewide antimicrobial stewardship efforts. Funding: None Disclosures: Michelle Doll reports a research grant from Molnlycke Healthcare.

Exploring provider density and socioeconomic factors contributing to HPV vaccination uptake among Virginia residents

Objective: Despite strong CDC recommendations and a state school requirement, nearly half of all adolescents in Virginia have not completed the HPV vaccine series. Using ArcGIS software, we aimed to explore the relationship between provider density, socioeconomic and demographic factors, and HPV vaccination uptake in the state of Virginia.

A Descriptive Analysis of Outpatient Antimicrobial Use for Urinary Tract Infections in Virginia

Background: Data regarding outpatient antibiotic prescribing for urinary tract infections (UTIs) are limited, and they have never been formally summarized in Virginia. Objective: We describe outpatient antibiotic prescribing trends for UTIs based on gender, age, geographic region, insurance payer and International Classification of Disease, Tenth Revision (ICD-10) codes in Virginia. Methods: We used the Virginia All-Payer Claims Database (APCD), administered by Virginia Health Information (VHI), which holds data for Medicare, Medicaid, and private insurance. The study cohort included Virginia residents who had a primary diagnosis of UTI, had an antibiotic claim 0–3 days after the date of the diagnosis and who were seen in an outpatient facility in Virginia between January 1, 2016, and December 31, 2016. A diagnosis of UTI was categorized as cystitis, urethritis or pyelonephritis and was defined using the following ICD-10 codes: N30.0, N30.00, N30.01, N30.9, N30.90, N30.91, N39.0, N34.1, N34.2, and N10. The following antibiotics were prescribed: aminoglycosides, sulfamethoxazole/trimethoprim (TMP-SMX), cephalosporins, fluoroquinolones, macrolides, penicillins, tetracyclines, or nitrofurantoin. Patients were categorized based on gender, age, location, insurance payer and UTI type. We used χ2 and Cochran-Mantel-Haenszel testing. Analyses were performed in SAS version 9.4 software (SAS Institute, Cary, NC). Results: In total, 15,580 patients were included in this study. Prescriptions for antibiotics by drug class differed significantly by gender (P &lt; .0001), age (P &lt; .0001), geographic region (P &lt; .0001), insurance payer (P &lt; .0001), and UTI type (P &lt; .0001). Cephalosporins were prescribed more often to women (32.48%, 4,173 of 12,846) than to men (26.26%, 718 of 2,734), and fluoroquinolones were prescribed more often to men (53.88%, 1,473 of 2,734) than to women (47.91%, 6,155 of 12,846). Although cephalosporins were prescribed most frequently (42.58%, 557 of 1,308) in northern Virginia, fluoroquinolones were prescribed the most in eastern Virginia (50.76%, 1677 of 3,304). Patients with commercial health insurance, Medicaid, and Medicare were prescribed fluoroquinolones (39.31%, 1,149 of 2,923), cephalosporins (56.33%, 1,326 of 2,354), and fluoroquinolones (57.36%, 5,910 of 10,303) most frequently, respectively. Conclusions: Antibiotic prescribing trends for UTIs varied by gender, age, geographic region, payer status and UTI type in the state of Virginia. These data will inform future statewide antimicrobial stewardship efforts.Funding: NoneDisclosures: Michelle Doll reports a research grant from Molnlycke Healthcare.