Data Resource Profile: The National Cancer Institute's Health Information National Trends Survey (HINTS)

Cervical Cancer Screening Rates Among Rural and Urban Females, From 2019 to 2022

Importance

Little nationally representative research has examined Papanicolaou testing rates from before the pandemic in 2019 through the COVID-19 pandemic in 2022. Papanicolaou testing rates among rural females are a concern as they have historically had lower screening rates than their urban counterparts.

Objective

To examine the receipt of a Papanicolaou test in the past year among US females overall and females residing in rural and urban areas in 2019, 2020, and 2022.

Design, Setting, and Participants

This repeated cross-sectional study used data from 3 years of the Health Information National Trends Survey (HINTS), a nationally representative survey that asks respondents about cancer screenings, sources of health information, and health and health care technologies. Study participants were females aged 21 to 65 years. Individuals who received a Papanicolaou test more than 1 to 3 years prior to a HINTS interview were excluded as they were likely not due for a Papanicolaou test.

Exposures

Survey year (2019, 2020, and 2022) and rural or urban residence were the main exposure variables.

Main Outcomes and Measures

Self-reported receipt of a Papanicolaou test within the past year.

Results

Among the 188 243 531 (weighted; 3706 unweighted) females included in the analysis, 12.5% lived in rural areas and 87.5% in urban areas. Participants had a mean (SE) age of 43.7 (0.27) years and were of Hispanic (18.8%), non-Hispanic Asian (5.2%), non-Hispanic Black (12.2%), non-Hispanic White (59.6%), or non-Hispanic other (4.1%) race and ethnicity. In 2022, unadjusted past-year Papanicolaou testing rates were significantly lower among rural vs urban residents (48.6% [95% CI, 39.2%-58.1%] vs 64.0% [95% CI, 60.0%-68.0%]; P < .001). Adjusted odds of past-year Papanicolaou testing were lower in 2022 than 2019 (odds ratio, 0.70; 95% CI, 0.52-0.95; P = .02).

Conclusions and Relevance

This repeated cross-sectional study found that past-year Papanicolaou testing rates were lower in 2022 than 2019, pointing to a need to increase access to screenings to prevent an uptick in cervical cancer incidence. Rural-vs-urban differences in 2022 indicate a need to specifically target rural females.

Does Climate Change Affect Health? Beliefs from the Health Information National Trends Survey

Climate change is currently and will continue impacting human health, however, beliefs about the level of threat vary by demographics, region, and ideology. The purpose of this study was to assess factors related to climate change and health beliefs using cross-sectional data from the Health Information National Trends Survey (HINTS). Data from 5,075 respondents in the 2022 iteration of HINTS was used for this study. Chi-square tests were used to evaluate demographic differences among those who believe climate change will harm health a lot compared to some, a little, or not at all. Generalized ordinal logistic regression models were used to examine the relationship between the belief that climate change will harm health and independent variables regarding trust in scientists, health recommendations from experts, and demographic characteristics. Female, Black, Hispanic, and college graduate respondents had higher odds and people in the Southern U.S. those aged 35-49, 50-64, and 75years or older had significantly lower odds of believing climate change would harm their health. Those who trust information about cancer from scientists and those that believe health recommendations from experts conflict or change had higher odds of believing climate change would harm health. Our analysis highlights factors that impact climate change and health beliefs, which may provide targets for tailoring public health messages to address this issue.

Perceptions of the Addictiveness of Low-Nicotine Cigarettes Versus Typical Cigarettes and Exposure to Tobacco Industry-Sponsored Corrective Campaign

BACKGROUND

In 2017, the U.S. Food and Drug Administration (FDA) announced a regulatory plan to reduce the nicotine content of cigarettes. This study examines the association of exposure to industry-sponsored corrective statements on perceptions of the addictiveness of low-nicotine cigarettes relative to typical cigarettes within the general US population.

METHODS

The study comprised 4975 US adult respondents of the 2019 Health Information National Trends Survey (HINTS 5, Cycle 3). Multinomial logistic regression models were used to examine associations between exposure to tobacco industry corrective messages and perceptions of the addictiveness of low-nicotine cigarettes relative to typical cigarettes.

RESULTS

In the overall population, 4.1% reported that low-nicotine cigarettes were much more addictive than typical cigarettes, 67.5% said they were equally addictive, while 28.4% reported they were slightly/much less addictive. Adults exposed to industry-sponsored corrective messages had higher odds of perceiving low-nicotine cigarettes as equally addictive as typical cigarettes (aOR 1.57; 95% CI, 1.13-2.19) than those who saw no corrective messages. Those exposed to the corrective messages specifically about the addictiveness of smoking and nicotine had higher odds of perceiving low-nicotine cigarettes as equally addictive as typical cigarettes (aOR, 1.73; 95% CI, 1.07-2.81) compared to those who saw no corrective message.

CONCLUSIONS

Our findings suggest that exposure to court-ordered tobacco industry corrective statements may have reinforced perceptions on the addictive potential of nicotine. However, study findings indicate a need for campaigns specifically tailored to address misperceptions observed in this study.

Prevalence and Factors Associated With Awareness of Precision Medicine Among Individuals With Depression and Anxiety

OBJECTIVE

This study investigates the prevalence and determinants of awareness of precision medicine among a nationally representative sample of individuals with self-reported depression and anxiety in the United States."

METHODS

Data were obtained from the Health Information National Trends Survey (HINTS) 5, Cycle 4, which is a study administered by the National Cancer Institute and is nationally representative. The survey, conducted between February and June 2020, targeted non-institutionalized, civilian US adults aged 18 years and older. Utilizing survey-weighted logistic regression, predictors of precision medicine awareness were assessed, encompassing sociodemographic, health-related, and technological factors.

RESULTS

Among 890 individuals with self-reported depression and/or anxiety, approximately 15.3% reported awareness of precision medicine. Participants who had a higher level of education and those who had increased health-linked social media usage were three times more likely to be aware of precision medicine compared to those who did not. Old age was also positively associated with increased awareness.

CONCLUSION

The present study's findings have disclosed an alarming lack of awareness of precision medicine, particularly among mentally ill persons with anxiety or depression, in which the targeted subgroups, including individuals with lower education levels and limited health-linked social media utilization, indicated lower levels of awareness. As such, it is recommended that such disparities be tackled using customized interventions along with educational initiatives, as this is likely to improve awareness levels while also ensuring equitable and increased access to precision medicine within the context of mental health.

Who uses connected health technologies after a cancer diagnosis? evidence from the US Health Information National Trends Survey

PURPOSE

As the number of people living with and beyond cancer increases, connected health technologies offer promise to enhance access to care and support, while reducing costs. However, uptake of connected health technologies may vary depending on sociodemographic and health-related variables. This study aimed to investigate demographic and health predictors of connected health technology use among people living with and beyond cancer.

METHODS

Cross-sectional data from the US Health Information National Trends Survey Version 5 Cycle 4 (H5c4) was used. Regression analysis was used to examine associations between sociodemographic factors and the use of connected health technologies. The sample was restricted to individuals who self-reported a cancer diagnosis or history of cancer.

RESULTS

In this cycle, 626 respondents self-reported a cancer diagnosis, with 41.1% using connected health technologies (health and wellness apps and/or wearable devices). Most were female (58.9%) and white (82.5%); 43.4% had graduated college or higher education. One third (33.6%) had a household income of $75,000 or more. Respondents who were younger, have higher education, were living as married, had higher incomes, had higher self-rated health and had higher health-related self-efficacy were significantly more likely to use connected health technologies. There were no significant associations between gender, race, stratum, time since diagnosis, history of anxiety or depression, and use of connected health technologies among people living with and beyond cancer.

CONCLUSIONS

Connected health technology use among people living with and beyond cancer is associated with sociodemographic factors. Future research should examine these demographic disparities as the use of connected health technologies in healthcare continues to gather momentum.

IMPLICATIONS FOR CANCER SURVIVORS

The study underscores a disparity in connected heath technology usage among people living with and beyond cancer. There is a pressing need for research into adoption barriers and interventions to ensure equitable digital healthcare integration among this population, especially with the heightened adoption of technology post COVID-19 pandemic.

Patients' perceptions of patient-centered communication with healthcare providers and associated factors in Japan - The INFORM Study 2020

OBJECTIVE

To describe patients' perceptions of the patient-centeredness of their communication with healthcare providers in Japan, and to examine factors associated with these perceptions.

METHODS

We analyzed the cross-sectional data from the INFORM Study 2020, which is a nationwide survey on health information access in Japan. A total of 3605 respondents completed the survey. Our primary outcome was the nine elements of the patient-centered communication scale (PCCS), which was compiled from 2703 respondents (75.0%) reporting at least one provider visit within 12 months. It was rated on a four-point Likert scale: always, usually, sometimes, and never. We used binary logistic regression to examine the association between sociodemographic and health-related variables, and each element of the PCCS.

RESULTS

For all elements, the percentage of respondents who agreed that their healthcare providers always communicated in a patient-centered way was low (17-31%). Patients with higher age, higher education, poorer general health status and a larger number of visits to providers in the previous 12 months were more likely to have positive perception.

CONCLUSION

Patient-centered communication as reported in a national sample in Japan was low.

CLINICAL IMPLICATIONS

Efforts are needed to improve the patient-centeredness of patient-provider communication in Japan to optimize health outcomes.

From Information Seeking and Scanning to the Practice of Healthy Habits: A Longitudinal Test of the Integrative Model of Behavioral Prediction in the Context of Fruit and Vegetable Consumption

Fruit and vegetable intake is essential for health, but global adherence to recommended levels remains insufficient. Health information exposure positively influences consumption, yet the underlying mechanisms are not fully understood. This study aims to explore the relationships between information seeking and scanning, attitudes, norms, perceived behavioral control (PBC), intentions, and fruit and vegetable intake, following the main tenets of the Integrative Model of Behavioral Prediction (IM). Data were collected through face-to-face surveys in Santiago, Chile, with a representative sample of individuals aged 25 and older in two waves. Findings revealed that intentions in Wave 1 predicted fruit and vegetable consumption in Wave 2, with positive associations between attitudes, norms, PBC, and intentions. Information seeking was positively associated with attitudes, norms, and PBC, and it had indirect effects on fruit and vegetable consumption through attitudes, norms, PBC, and intentions. Information scanning did not show significant indirect effects on fruit and vegetable consumption, even though the path between scanning and attitudes was significant. The study provides support for the IM and highlights the importance of information seeking in promoting fruit and vegetable consumption through its influence on attitudes, norms, and PBC. The findings have practical implications for health campaigns, educational programs, healthcare interactions, and public policies targeting healthier dietary habits.

Breast Cancer Risk Perceptions Among Underserved, Hispanic Women: Implications for Risk-Based Approaches to Screening

BACKGROUND

Understanding factors that shape breast cancer risk perceptions is essential for implementing risk-based approaches to breast cancer detection and prevention. This study aimed to assess multilevel factors, including prior screening behavior, shaping underserved, Hispanic women's perceived risk for breast cancer.

METHODS

Secondary analysis of survey data from Hispanic women (N = 1325, 92% Spanish speaking, 64% < 50) enrolled in a large randomized controlled trial. Analyses were performed in two cohorts to account for the role of age on screening guideline recommendations (< 50 and 50 +). For each cohort, we examined differences in three common measures of perceived risk of breast cancer (percent lifetime, ordinal lifetime, comparative) by participant factors with chi-square or Kruskal-Wallis tests, as appropriate. Multivariate analyses examined the association between mammography history with percent perceived lifetime risk (outcome > 10 vs ≤ 10%).

RESULTS

Overall, 75% reported a lifetime risk between 0 and 10%, 96% rated their ordinal risk as "not high," and 50% rated their comparative risk as "much lower." Women < 50 with a family history of breast cancer reported significantly higher levels of perceived risk across all three measures. Among women 50 + , those reporting lower levels of perceived risk were significantly more likely to be Spanish speaking. No significant association was observed between mammography history and percent lifetime risk of breast cancer.

CONCLUSION

Factors shaping breast cancer risk perceptions differ by age. Prior screening may play less of role in constructing risk perceptions. Research is needed to develop culturally and linguistically appropriate strategies to improve implementation of risk-based screening.

Genetic Testing for Cancer Risk and Perceived Importance of Genetic Information Among US Population by Race and Ethnicity: a Cross-sectional Study

BACKGROUND

Genetic testing can help determine the risk of many cancers and guide cancer prevention and treatment plans. Despite increasing concern about disparities in precision cancer medicine, public knowledge and cancer genetic testing by race and ethnicity have not been well investigated.

METHODS

We analyzed data from the 2020 Health Information National Trends Survey in 2022. Self-reported cancer genetic testing (e.g., Lynch syndrome, BRCA1/2) knowledge and utilization were compared by race and ethnicity. Perceived importance of genetic information for cancer care (prevention, detection, and treatment) was also examined in relation to the uptake of cancer genetic testing. Multivariable logistic regression models were employed to examine factors associated with knowledge and genetic testing to calculate predicted probability of undergoing genetic testing by race and ethnicity.

RESULTS

Of 3551 study participants, 37.8% reported having heard of genetic testing for cancer risk and 3.9% stated that they underwent cancer genetic testing. Being non-Hispanic Black (OR=0.47, 95% CI=0.30-0.75) or Hispanic (OR=0.56, CI=0.35-0.90) was associated with lower odds of genetic testing knowledge. Although Hispanic or non-Hispanic Black respondents were more likely to perceive higher importance of genetic information versus non-Hispanic Whites, they had a lower predicted probability of cancer genetic testing.

CONCLUSION

Non-Hispanic Black and Hispanic adults had lower knowledge and were less likely to undergo cancer genetic testing than non-Hispanic Whites. Further research is needed on sources of genetic testing information for racial and ethnic minorities and the barriers to accessing genetic testing to inform the development of effective cancer risk genetic testing promotion.

Supporting Underserved Communities for Health Care: US Immigrants' Experiences with Social Support

Background

Social support is associated with improved clinical outcomes but is understudied among US immigrants. We examined two types of social support, perceived health provider support and community support, and characterized perceptions of social support among US immigrants compared with nonimmigrants.

Methods

We conducted cross-sectional data analysis on self-reported data from Health Information National Trends Survey 5, Cycle 2. Population-level estimates were obtained using jack-knife replicate weights.

Results

Immigrant status was not associated with perceived health care provider support or community support. However, compared with nonimmigrants, US immigrants were more likely to report rarely (adjusted odds ratio [aOR]=3.07) or never (aOR=3.18) having access to emotional support.

Conclusions

Further research that incorporates nuanced factors (eg, time since arrival) that may influence social support in diverse US immigrant groups is needed to determine the impact of social support on health outcomes in an underserved and often overlooked population.

Rationale, Procedures, and Response Rates for a Pilot Study to Sample Cancer Survivors for NCI's Health Information National Trends Survey: HINTS-SEER 2021

The National Cancer Institute's (NCI) Health Information National Trends Survey (HINTS) is a nationally representative survey of U.S. adults in which 12-17% of respondents report a cancer history. To increase representation from adult cancer survivors, in 2021, NCI sampled survivors from three Surveillance, Epidemiology, and End Results (SEER) program cancer registries: Iowa, New Mexico, and the Greater Bay Area. Sampling frames were stratified by time since diagnosis and race/ethnicity, with nonmalignant tumors and non-melanoma skin cancers excluded. Participants completed a self-administered postal questionnaire. The overall response rate for HINTS-SEER (N = 1,234) was 12.6%; a non-response bias analysis indicated few demographic differences between respondents and the pool of sampled patients in each registry. Most of the sample was 10+ years since diagnosis (n = 722; 60.2%); 392 respondents were 5 to < 10 years since diagnosis (29.6%); and 120 were < 5 years since diagnosis (10.2%). Common cancers included male reproductive (n = 304; 24.6%), female breast (n = 284; 23.0%), melanoma (n = 119; 9.6%), and gastrointestinal (n = 106; 8.6%). Tumors were mostly localized (67.8%; n = 833), with 22.4% (n = 282) regional, 6.2% (n = 72) distant, and 3.7% (n = 47) unknown. HINTS-SEER data are available by request and may be used for secondary analyses to examine a range of social, behavioral, and healthcare outcomes among cancer survivors.

Trust in Mass Media as Sources of Cancer Information: Findings from a Nationally Representative Cross-Sectional Survey in Japan

Trust is a major factor in effective public dissemination and use of relevant health information to guide important health decisions. To examine mass media as a communication channel for delivering cancer information among Japanese adults, we identified the level of trust in various types of mass media as sources of cancer information, and examined factors associated with trust, including exposure to mass media, sociodemographic factors, and cancer history. Data were analyzed for 3,109 Japanese adults who responded to a nationally representative cross-sectional mail survey. Data included trust in cancer information sources, sociodemographic variables, cancer history, and exposure to mass media. Logistic regression analysis was used. The prevalence of high trust in cancer information sources was highest for physicians (94.7%). Among mass media, Internet (47.2%) was the most trusted source of cancer-related information, followed by television (44.3%), newspapers/magazines (42.7%), and radio (32.7%). The high-exposure group for newspapers (AOR = 1.28, 95%CI = 1.07-1.54) was more likely to trust newspapers. Similarly, high-exposure groups for radio (1.22, 1.02-1.45), Internet (1.21, 1.01-1.45), and television (1.30, 1.10-1.53) were positively associated with trust in each media type. Although trust in mass media was lower than trust in physicians, the study found that a large group of respondents had high levels of trust in mass media sources. Trust in cancer information from each mass media type was mainly related to the level of exposure to each mass media type. Developing health communication strategies using mass media may be effective for disseminating relevant cancer information in Japan.

Cancer worry and its impact on self-reported depressive symptoms among adult males and females in the US: a nationwide sample study

OBJECTIVE

With cancer the second deadliest disease in the world, worry about cancer can have mental health or psychiatric implications. This study examines the prevalence, differences, and influence of cancer worry (CW), its interaction effect with age, and other confounders on self-reported depressive symptoms (SRDS) among adult males and females in the US.

METHODS

We utilized a nationally representative sample data of 2,950 individuals (males = 1,276; females = 1,674) from Cycle 4 of the Health Information National Trends Survey 5 (HINTS 5) 2020. Using frequencies, bivariate chi-square test, and multivariate logistic regression, we examined the prevalence, difference, and association of CW with SRDS, adjusting for confounders.

RESULTS

The prevalence rate of SRDS was found to be 32% among females and 23.5% among males. Among individuals with CW, females had a higher prevalence of SRDS compared to males (40.5% vs. 35.1%). However, there was a significant difference in the likelihood of experiencing SRDS between males and females with CW, with males having 84% increased risk compared to females. Across all age groups, the multivariate analysis of the relationship between CW and SRDS revealed that both males and females showed a significantly decreased likelihood of SRDS compared to those aged 18-34 years. However, males aged 35 years or older exhibited an even more pronounced decrease in likelihood compared to females in the same age group. Nonetheless, when examining the interaction of age and CW, we observed a significantly increased likelihood of SRDS across all age groups. Males, in particular, had a higher increased likelihood of SRDS compared to females across all ages, except for those aged 75 years and older.

CONCLUSION

The findings of this study highlight the significant influence of CW on individuals' SRDS and the modifying effect of age, particularly among males. These results are important for a better understanding of the risk of CW on mental health, which can be a preventive strategy or control mechanism.

Associations of individual characteristics and socioeconomic status with heated tobacco product harmfulness perceptions in Japan: A nationwide cross-sectional study (INFORM Study 2020)

IntroductionIn Japan, heated tobacco products (HTPs) are promoted by the tobacco industry as reduced-risk tobacco products despite the lack of evidence for this claim. This study determined the distribution of HTP-harmfulness perception and identify the explanatory factors associated with the perception of HTP as less harmful than conventional cigarettes.MethodsA nationwide cross-sectional survey was conducted with Japanese people aged 20 years or older (INFORM Study 2020) using a self-administered questionnaire. We performed descriptive analysis and weighted logistic regression analysis to examine the relationship between explanatory factors (e.g., individual characteristics, socioeconomic status, and trusted sources of cancer information) and the perception of HTPs as less harmful.ResultsAmong 3,420 participants (response rate: 35.2%), the proportions of those who perceived HTPs as less harmful were 40.3% and 18.3% for users and non-users of tobacco, respectively. For participants aged 20-39 years, the proportion were 49.9% and 30.4%, respectively. Among 1,160 non-tobacco users who were familiar with HTPs, male, aged under 39 years, and had lower education were associated with the perception of HTPs as less harmful. Trusted sources of cancer information were not associated with the perception of HTPs as less harmful.ConclusionsThis study showed that, among non-tobacco users, being male, aged under 39 years, and lower education were associated with a perception of HTPs as less harmful. Public health stakeholders should provide the latest evidence about HTP harmfulness in their daily practice, and strengthen the regulations on HTP marketing directed at both tobacco- and non-tobacco users.

Palliative Care Knowledge and Attitudes Among Patients With Neuroinflammatory Diseases

Background: Neuroinflammatory diseases are progressive leading to loss of function and disability. Although palliative care (PC) utilization has increased globally, it has scarcely increased in neurology. Objectives: To explore PC attitudes and knowledge among patients with neuroinflammatory diseases, such as multiple sclerosis, neuromyelitis optica spectrum disorder, and myelin oligodendrocyte glycoprotein antibody-associated disease. Methods: A cross-sectional 1-year study was conducted using the Palliative Care Knowledge Scale (PaCKS) and the PC Health Information National Trends Survey (HINTS). Murray's transition theory guided this study, which integrates palliative services including decision making, communication, and coordinated care. Results: The majority of study patients were female (69%) (N = 86) and White (79%). Forty-two percent indicated that they had never heard about PC, 46% said that they knew a little bit about PC, and 12% said that they knew a lot about PC. Fifty percent of patients knew the goals of PC and had knowledge about PC services. Forty-four percent to 60% agreed that PC goals include helping friends and family to cope with a patient's illness, offering social and emotional support, and managing pain and other symptoms. Patients who self-reported being familiar with PC performed significantly better on the PaCKS than those unfamiliar with PC (p < 0.001), and those who self-reported moderate or severe memory loss performed significantly worse on the PaCKS than those with mild memory loss (p = 0.027). There was an association between higher education and PC knowledge and between patients' PaCKS scores and their self-reported HINTS PC knowledge. Conclusions: Patients have partial PC knowledge. Patients require education about PC early in their disease along their illness trajectory.

Socioeconomic and clinical risk factors associated with moderate intensity physical activity before and during the COVID-19 pandemic

Although moderate intensity physical activity (MIPA) improves general mental health, morbidity, and mortality, the COVID-19 pandemic may have adversely impacted individuals' ability to engage in MIPA. We examined the extent of socioeconomic factors, body mass index, anxiety/depression, and cancer diagnosis associated with MIPA before and during the COVID-19 pandemic. Multivariable logistic regression models were conducted on 4,551 U.S. adults aged 18-64 years using nationally representative samples from the 2019 and 2020 Health Information National Trends Survey datasets. The prevalence of MIPA before the pandemic was higher (77.07%) than during the pandemic (76.21%). Before the COVID-19 pandemic, lower odds of MIPA were observed for individuals with fair/poor health (OR = 0.24, 95% CI = 0.27, 0.63), obesity (OR = 0.51, 95% CI = 0.33, 0.79), anxiety/depression (OR = 0.60, 95% CI = 0.42, 0.85), or a cancer diagnosis (OR = 0.56, 95% CI = 0.32, 0.98). During the pandemic, lower odds were observed among those with obesity (OR = 0.44, 95% CI = 0.28, 0.70), anxiety/depression (OR = 0.61, 95% CI = 0.43, 0.86), less than high school education (OR = 0.33, 95% CI = 0.16, 0.70), or family income of $20,000 - $34,999 (OR = 0.42, 95% CI = 0.24, 0.74). There was a decline in MIPA during the pandemic, with certain subgroups, such as individuals of lower socioeconomic and physical and mental health status, less likely to engage in MIPA. This study highlights the need for concerted physical activity educational strategies aimed at improving access to and utilization of MIPA within subgroups to reduce MIPA disparities, particularly among disadvantaged groups during pandemics.

Association of financial worry with substance use, mental health, and quality of life in cancer patients

PURPOSE

Financial worry is an under-appreciated negative effect of cancer. The relationship of financial worry and health behaviors in cancer is poorly characterized and has important clinical implications. This study examined the association of financial worry with substance misuse, mood, and quality of life.

METHODS

People with cancer (n = 1473; 6 to 20 months after diagnosis) were recruited from a SEER cancer registry in the Pacific Northwest. Participants completed an online survey assessing financial worry; misuse of cannabis, alcohol, and prescription drugs; tobacco smoking status; quality of life (physical and mental dimensions); anxiety; and depression. Multivariable regressions tested the association of financial worry to each health indicator and outcome.

RESULTS

In adjusted analyses, financial worry was associated with being a current vs. never smoker (odds ratio (OR) = 1.91, 95% confidence interval (CI): 1.01, 3.60), and a positive screen for an anxiety (OR = 3.01, 95% CI: 1.93, 4.68) and depressive (OR = 3.08, 95% CI: 1.89, 5.00) disorder. Financial worry was not associated with cannabis, alcohol, or prescription drug misuse (all ps > 0.05), but was associated with a decrease in physical (β =  - 2.97, 95% CI: - 4.15, - 1.79) and mental (β =  - 5.27, 95% CI: - 6.59, - 3.96) quality of life.

CONCLUSION

Financial worry among cancer survivors is associated with anxiety, depression, and worse quality of life. Of the evaluated substances, there was only an increased odds of current tobacco use with financial worry. Future longitudinal studies should inform the relationships between these factors.

IMPLICATIONS FOR CANCER SURVIVORS

Financial worry and material hardship may both need to be addressed in cancer survivorship.

The influence of political ideology on clinical trial knowledge, invitation, and participation among adults in the United States

BACKGROUND

Clinical trials remain a critical component of medical innovation. Evidence suggests that individuals' political ideologies may impact their health behaviors. However, there is a paucity of literature examining the relationship between political ideologies and clinical trial knowledge and participation.

METHODS

Study data were derived from Health Information National Trends Survey 5 Cycle 4 (n = 3300), which was conducted from February to June 2020. We used participants' characteristics to estimate the prevalence of clinical trial knowledge and participation. We used multivariable logistic regressions to investigate whether political ideology had a significant impact on clinical trial knowledge and participation. Jack-knife replicate weights were applied for population-level estimates.

RESULTS

Most participants were White (64.2%), earned above US$50,000 (62.4%), and lived in urban areas (88.0%). About 59.2% reported having some knowledge of clinical trials, and only 8.9% had ever been invited to participate in clinical trials. A total of 37.0%, 29.5%, and 33.5% of the population endorsed moderate, liberal, and conservative political viewpoints respectively. In the adjusted logistic regression analysis, compared to conservatives, liberals (adjusted odds ratio, 1.92; 95% confidence interval, 1.31-2.80) and moderates (adjusted odds ratio, 1.43; 95% confidence interval, 1.09-1.88) had significantly greater odds of having knowledge of clinical trials. Also, liberals had higher odds of receiving invitations to participate in clinical trials (odds ratio, 1.76; 95% confidence interval, 1.08-2.85; p = 0.023) and greater odds of trial participation (odds ratio, 3.90; 95% confidence interval, 1.47-10.33; p = 0.007) compared to moderates.

CONCLUSIONS

The mechanism underlying the higher rates of clinical trial invitations to liberals is unclear and requires further comprehensive investigation. Similarly, further qualitative studies are needed to understand the attributes that promote knowledge and increased likelihood of clinical trial participation among liberals. This will provide crucial insight to help design interventions that further involve conservatives and moderates in clinical trials and scientific enterprise.

Patient centeredness, independent health-related Internet use, and online communication with healthcare providers in later life: A cross-sectional study

OBJECTIVE

To test the links between patient centeredness, independent health-related Internet use, and online communication with healthcare provider in later life.

METHODS

These links were tested on a multivariable level through the prism of the socioemotional selectivity theory and the channel complementarity theory. The data were obtained from the Health Information National Trends Survey (Wave 5, Cycle 4) and analyzed using logistic regression models. The sample included older Internet users (N = 1165).

RESULTS

Low patient centeredness corresponded to a decreased likelihood of communicating with healthcare providers online. No particular patient centeredness component was associated with the studied phenomenon. Online health information seeking corresponded to an increased likelihood of communicating with healthcare providers online.

CONCLUSION

Patient centeredness plays a relatively modest role in explanation of the online communication with healthcare providers in later life. In addition, older adults' online health information seeking behavior and online patient-provider communication seem to complement each other.

PRACTICE IMPLICATIONS

The findings can serve public health officials for developing programs aimed at increasing the rates of the online communication with healthcare providers in older population. The findings can also serve healthcare providers in their efforts to improve the quality of (online) communication with their older patients.

Age, gender and socioeconomic disparities in human papillomavirus (HPV) awareness and knowledge among Japanese adults after a 7-year suspension of proactive recommendation for the HPV vaccine: A nationally representative cross-sectional survey

The Japanese government's 2013 suspension of its proactive recommendation for Human papillomavirus (HPV) vaccination resulted in low HPV vaccination coverage and was unique. However, data on awareness and knowledge of HPV vaccines in the general population was limited. Here, to investigate more recent awareness and knowledge of HPV vaccines by age, gender, and socioeconomic status, we used data from the INFORM Study 2020, a nationally representative cross-sectional survey of self-administered questionnaires with 1,998 Japanese individuals aged 20 to 59 years. We found that 47.5% of females and 21.0% of males had heard of HPV, and 33.6% of females and 16.8% of males had knowledge of HPV vaccine efficacy. After adjusting for potential confounders, females aged 50-54 years were more likely to be aware of HPV than females aged 20-24 (AOR, 2.02, 95%CI: 1.12-3.65). Females (AOR, 2.13, 95%CI: 1.48-3.07) and males (AOR, 1.64, 95%CI: 1.03-2.59) with higher education had more awareness than those with less education. Females with higher education had more knowledge about HPV vaccine efficacy than those with less education (AOR, 1.70; 95%CI: 1.16-2.50). We found a generally low level of awareness and knowledge about HPV vaccines in Japan, which might be attributable to the suspension of proactive recommendations. Additionally, we identified disparities in awareness and knowledge by age, gender, socioeconomic status, and health literacy. Enhancing HPV awareness and understanding of HPV vaccines and implementing targeted efforts for specific subpopulations within Japan after the resumption of proactive recommendation for HPV vaccines, are imperative.

Knowledge of the health consequences of heavy alcohol consumption among individuals with different substance use statuses: A cross-sectional analysis of 2019 HINT Survey

OBJECTIVE

The aim of this study was to assess and compare knowledge of the health consequences of heavy alcohol consumption among individuals with different substance use statuses.

METHODS

We used a cross-sectional study design to analyze the Health Information National Trends Survey (HINTS) 5, Cycle 3 (2019). Participants were classified into four categories based on their substance use status: (a) nonsmoker and nondrinkers; (b) nonsmokers but drinkers; (c) smokers but nondrinkers; and (d) smokers and drinkers. Weighted logistic regression models were utilized to evaluate the association between knowledge of heavy alcohol consumption and health conditions by participants' substance use status.

RESULTS

More than 79% of participants were aware that drinking too much alcohol causes liver disease. However, less than 40% of them realized that heavy alcohol consumption also contributes to cancer. The odds of correctly identifying heavy alcohol consumption as a risk factor for diabetes were 3.00 times (95% confidence interval (CI): 1.29,7.00) higher among smokers but nondrinkers than smokers and alcohol drinkers. Education level was significantly associated with participants' awareness of risk factor (p < 0.01).

DISCUSSION

There is an urgent need for targeted educational campaigns and interventions to increase understanding of the impact of heavy alcohol consumption on cancer risk.

Psychometric Evaluation of the Modes of Health Information Acquisition, Sharing, and Use Questionnaire: Prospective Cross-Sectional Observational Study

BACKGROUND

Health information is a critical resource for individuals with health concerns and conditions, such as hypertension. Enhancing health information behaviors may help individuals to better manage chronic illness. The Modes of Health Information Acquisition, Sharing, and Use (MHIASU) is a 23-item questionnaire that measures how individuals with health risks or chronic illness acquire, share, and use health information. Yet this measure has not been psychometrically evaluated in a large national sample.

OBJECTIVE

The objective of this study was to evaluate the psychometric properties of the self-administered MHIASU in a large, diverse cohort of individuals living with a chronic illness.

METHODS

Sharing Information, a prospective, observational study, was launched in August 2018 and used social media campaigns to advertise to Black women. Individuals who were interested in participating clicked on the advertisements and were redirected to a Qualtrics eligibility screener. To meet eligibility criteria individuals had to self-identify as a Black woman, be diagnosed with hypertension by a health care provider, and live in the United States. A total of 320 Black women with hypertension successfully completed the eligibility screener and then completed a web-based version of the MHIASU questionnaire. We conducted a psychometric evaluation of the MHIASU using exploratory factor analysis. The evaluation included item review, construct validity, and reliability.

RESULTS

Construct validity was established using exploratory factor analysis with principal axis factoring. The analysis was constricted to the expected domains. Interitem correlations were examined for possible item extraction. There were no improvements in factor structure with the removal of items with high interitem correlation (n=3), so all items of the MHIASU were retained. As anticipated, the instrument was found to have 3 subscales: acquisition, sharing, and use. Reliability was high for all 3 subscales, as evidenced by Cronbach α scores of .81 (acquisition), .81 (sharing), and .93 (use). Factor 3 (use of health information) explained the maximum variance (74%).

CONCLUSIONS

Construct validity and reliability of the web-based, self-administered MHIASU was demonstrated in a large national cohort of Black women with hypertension. Although this sample was highly educated and may have had higher digital literacy compared to other samples not recruited via social media, the population captured (Black women living with hypertension) are often underrepresented in research and are particularly vulnerable to this chronic condition. Future studies can use the MHIASU to examine health information behavior in other diverse populations managing health concerns and conditions.

Use of Smart Devices to Track Cardiovascular Health Goals in the United States

BACKGROUND

Smartphone-based health applications are increasingly popular, but their real-world use for cardiovascular risk management remains poorly understood.

OBJECTIVES

The purpose of this study was to investigate the patterns of tracking health goals using smart devices, including smartphones and/or tablets, in the United States.

METHODS

Using the nationally representative Health Information National Trends Survey for 2017 to 2020, we examined self-reported tracking of health-related goals (optimizing body weight, increasing physical activity, and/or quitting smoking) using smart devices among those with cardiovascular disease (CVD) or cardiovascular risk factors of hypertension, diabetes, obesity, and/or smoking. Survey analyses were used to obtain national estimates of use patterns and identify features associated with the use of these devices for tracking health goals.

RESULTS

Of 16,092 Health Information National Trends Survey participants, 10,660 had CVD or cardiovascular risk factors, representing 154.2 million (95% CI: 149.2-159.3 million) U.S. adults. Among the general U.S. adult population, 46% (95% CI: 44%-47%) tracked their health goals using their smart devices, compared with 42% (95% CI: 40%-43%) of those with or at risk of CVD. Younger age, female, Black race, higher educational attainment, and greater income were independently associated with tracking of health goals using smart devices.

CONCLUSIONS

Two in 5 U.S. adults with or at risk of CVD use their smart devices to track health goals. While representing a potential avenue to improve care, the lower use of smart devices among older and low-income individuals, who are at higher risk of adverse cardiovascular outcomes, requires that digital health interventions are designed so as not to exacerbate existing disparities.

Understanding Associations of Personal Values With Support for Tobacco and Alcohol Control Policies

INTRODUCTION

This cross-sectional analysis of the 2020 Health Information National Trends Survey (N=3,604) examines the associations of personal values with tobacco and alcohol control policy support, which may inform policy-related communication efforts.

METHODS

Respondents selected which of 7 value options they considered most important in their daily life and rated their support for 8 proposed tobacco and alcohol control policies (1=strongly oppose, 5=strongly support). Weighted proportions for each value were described across sociodemographic characteristics, smoking status, and alcohol use. Weighted bivariate and multivariable regressions tested the associations of values with mean policy support (alpha=0.89). Analyses occurred from 2021 to 2022.

RESULTS

The most frequently selected values were assuring my family is safe and secure (30.2%), being happy (21.1%), and making my own decisions (13.6%). Selected values varied across sociodemographic and behavioral characteristics. For example, people with lower education and incomes were overrepresented among those selecting making my own decisions and keeping myself in good health. After adjusting for sociodemographics, smoking, and alcohol use, people selecting family safety (β=0.20, 95% CI=0.06, 0.33) or religious connection (β=0.34, 95% CI=0.14, 0.54) as most important reported higher policy support than those selecting making their own decisions, the value associated with the lowest mean policy support. Mean policy support did not significantly differ across any other value comparisons.

CONCLUSIONS

Personal values are associated with support for alcohol and tobacco control policies, with making my own decisions associated with the lowest policy support. Future research and communication efforts may consider aligning tobacco and alcohol control policies with the idea of supporting autonomy.

Association Between Wearable Device Use and Levels of Physical Activity Among Older Adults in the US: Evidence From the 2019-2020 Health Information National Trends Survey

Objective To examine the relationship between electronic wearable device (WD) use and physical activity (PA) levels among older adults in the US. Methods Data were pooled from 3310 older adults from the 2019 and 2020 Health Information National Trends Survey. The explanatory variable was WD use, and the outcomes were weekly PA levels, resistance training, and sedentary time. Logistic regression was conducted to investigate the association between WD use and the reported outcome variables. Separate logistic models were also fitted to explore the relationship between WD use and physical activity outcomes among a subgroup of older adults with chronic conditions. Results A total of 14.4% of older adults reported WD use. Older adults who use WD were more likely to meet national guidelines for weekly levels of PA (odds ratio (OR) 1.60, 95% confidence intervals (CI) (1.10, 2.32); p = 0.015) and resistance strength training (OR 1.54, 95% CI (1.14, 2.09); p = 0.005) when compared with their counterparts not using WD. After restricting the analysis to those with chronic conditions only, WD use was only associated with a higher level of weekly strength training (OR 1.68, 95% CI 1.19, 2.38; p = 0.004). Conclusion  WD use may be associated with increased physical activity among older adults, including those with chronic health conditions. Further studies are needed to examine the factors influencing the adoption and sustained use of WD in older adults.

Association Between Depression and Anxiety Status With Uptake of Colorectal Cancer Screening Among US Adults: A Population-Level Study

BACKGROUND

Individuals with different mental disorders tend to experience higher rates of colorectal cancer (CRC)-related mortality compared to the general population. Discrepancies in CRC screening behaviors have been suggested as a potential contributing factor to this difference in mortality. However, existing evidence on this topic has been inconclusive and conflicting.

OBJECTIVE

This study aims to explore the relationship between mental health status (specifically, depression and/or anxiety) and the uptake of CRC screening. To achieve this, a larger and nationally representative sample from the adult population of the United States was utilized.

METHODS

We employed a cross-sectional approach using data from the 2019-2020 edition of the Health Information National Trends Survey (HINTS). The study examined disparities in CRC screening between individuals with self-reported history of depression diagnosis and the general population. Chi-square tests were used for analysis. Multivariable logistic regression models were applied to adjust for variables such as gender, age, education level, race, comorbidities, healthcare access, smoking status, household income, geographical residence, and insurance status. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported.

RESULTS

The findings of the study indicated that out of 5,398 eligible individuals, approximately 1,220 (weighted percentage: 22.8%) reported experiencing depression and/or anxiety, and approximately 4,154 (weighted percentage: 68.9%) reported adherence to colorectal cancer screening. In the bivariate analysis, there was no significant difference in participation in colorectal cancer screening between individuals with and without depression and/or anxiety (72.0% vs. 68.0%). Similarly, after adjusting for sociodemographic and health-related factors, the study found that the odds of participating in colorectal cancer screening did not vary based on an individual's depression status (OR 1.34, 95% CI 0.94-1.91, P = 0.05).

CONCLUSION

Individuals with depression participate in colorectal cancer screening at comparable rates to the general population. The findings of this study suggest that factors beyond CRC screening may play significant roles in the higher CRC-associated mortality rate. Therefore, further research is needed to uncover the various mechanisms contributing to the increased cancer-related mortality rates among susceptible populations.

Effects of a Pragmatic Home-based Exercise Program Concurrent With Neoadjuvant Therapy on Physical Function of Patients With Pancreatic Cancer: The PancFit Randomized Clinical Trial

OBJECTIVE

To determine the effects of a preoperative, home-based exercise program on fitness and physical function in patients with pancreatic cancer.

BACKGROUND

We previously established a well-tolerated preoperative exercise program after finding a high frequency of sarcopenia and frailty in patients with pancreatic cancer.

METHODS

In this randomized, controlled trial (NCT03187951), patients with pancreatic cancer were randomized to Arm A: enhanced usual care or Arm B: prescribed aerobic and resistance exercise during neoadjuvant therapy. Patients received nutrition counseling and activity trackers. The primary endpoint was a 6-minute walk distance (6MWD; ≥14 meters improvement was clinically meaningful). Secondary endpoints included additional physical function tests, health-related quality of life, and clinical outcomes.

RESULTS

One hundred fifty-one patients were randomized. Objectively measured weekly activity (153.2±135.6 and 159.8±122.8 min in Arm A and B, respectively, P =0.62) and self-reported weekly moderate-to-strenuous physical activity (107.4±160.4 and 129.6±161.6 min in Arm A and Arm B, respectively, P =0.49) were similar, but weekly strength training sessions increased more in Arm B (by 1.8±1.8 vs 0.1±2.4 sessions, P <0.001). 6MWD improved in both Arm A (mean change 18.6±56.8 m, P =0.01) and Arm B (27.3±68.1 m, P =0.002). Quality of life and clinical outcomes did not significantly differ between arms. Pooling patients in both study groups, exercise, and physical activity was favorably associated with physical performance and clinical outcomes.

CONCLUSIONS

In this randomized trial of prescribed exercise versus enhanced usual care during neoadjuvant therapy for pancreatic cancer, a high volume of physical activity and increased exercise capacity were observed in both arms, highlighting the importance of activity among patients preparing for surgery.

Exploring Functions and Predictors of Digital Health Engagement Among German Internet Users: Survey Study

BACKGROUND

Digital health engagement may serve many support functions, such as providing access to information; checking or evaluating one's state of health; and tracking, monitoring, or sharing health data. Many digital health engagement behaviors are associated with the potential to reduce inequalities in information and communication. However, initial studies suggest that health inequalities may persist in the digital realm.

OBJECTIVE

This study aimed to explore the functions of digital health engagement by describing how frequently respective services are used for a range of purposes and how these purposes can be categorized from the users' perspective. This study also aimed to identify the prerequisites for successfully implementing and using digital health services; therefore, we shed light on the predisposing, enabling, and need factors that may predict digital health engagement for different functions.

METHODS

Data were gathered via computer-assisted telephone interviews during the second wave of the German adaption of the Health Information National Trends Survey in 2020 (N=2602). The weighted data set allowed for nationally representative estimates. Our analysis focused on internet users (n=2001). Engagement with digital health services was measured by their reported use for 19 different purposes. Descriptive statistics showed the frequency with which digital health services were used for these purposes. Using a principal component analysis, we identified the underlying functions of these purposes. Using binary logistic regression models, we analyzed which predisposing factors (age and sex), enabling factors (socioeconomic status, health- and information-related self-efficacy, and perceived target efficacy), and need factors (general health status and chronic health condition) can predict the use of the distinguished functions.

RESULTS

Digital health engagement was most commonly linked to acquiring information and less frequently to more active or interactive purposes such as sharing health information with other patients or health professionals. Across all purposes, the principal component analysis identified 2 functions. Information-related empowerment comprised items on acquiring health information in various forms, critically assessing one's state of health, and preventing health problems. In total, 66.62% (1333/2001) of internet users engaged in this behavior. Health care-related organization and communication included items on patient-provider communication and organizing health care. It was applied by 52.67% (1054/2001) of internet users. Binary logistic regression models showed that the use of both functions was determined by predisposing factors (female and younger age) and certain enabling factors (higher socioeconomic status) and need factors (having a chronic condition).

CONCLUSIONS

Although a large share of German internet users engage with digital health services, predictors show that existing health-related disparities prevail in the digital realm. To make use of the potential of digital health services, fostering digital health literacy at different levels, especially in vulnerable groups, is key.

Exploring the Prevalence and Factors Influencing Clinical Trial Awareness in US Adults with Self-Reported Depression and Anxiety

OBJECTIVE

Lack of clinical trial awareness is a crucial barrier to clinical trial enrollment. The objective of this study was to examine the prevalence and factors associated with clinical trial awareness among US adults with self-reported depression and anxiety.

METHODS

Data were collected from 896 adults who self-reported depression and anxiety from the 2020 Health Information National Trends Survey. Multinomial logistic regression was utilized to assess predictors of clinical trial awareness, particularly socio-demographic, health-related, and technological variables. Odds ratios (OR) for the associations were reported.

RESULTS

About 60.4% of adults with self-reported depression or anxiety reported being aware of clinical trials. In the multivariable regression, education level, health-related social media use, and having access to a regular provider were all significantly associated with greater odds of clinical trial awareness among individuals with depression and/or anxiety. Specifically, individuals with at least some college education (OR 2.07, 95% confidence interval (CI); 1.28-3.34; p ​= ​0.004) were more likely to report awareness of clinical trials than those with less than a college education. Similarly, compared to those without access to health providers, individuals with depression and/or anxiety who had a regular provider had greater odds of clinical trial awareness (OR 2.23, 95% CI; 1.16-4.31; p ​= ​0.017). Additionally, those who reported two or more health-related uses of social media were significantly more likely to report clinical trial awareness than their counterparts who reported no health-related social media use (OR 3.17, 95% CI; 1.48-6.80; p ​= ​0.004).

CONCLUSION

Our study shows that about six in 10 adults with depression and anxiety in the United States were aware of clinical trials. However, some sub-groups of patients, particularly those without access to a regular health provider, those with a lower education level, and those with limited use of social media for health purposes, remain inadequately informed and may lack awareness of available clinical trials. These findings are crucial and identify subgroups of people with mental disorders that may benefit from targeted interventions to improve clinical trial awareness.

Use of Wearable Devices in Individuals With or at Risk for Cardiovascular Disease in the US, 2019 to 2020

Importance

Wearable devices may be able to improve cardiovascular health, but the current adoption of these devices could be skewed in ways that could exacerbate disparities.

Objective

To assess sociodemographic patterns of use of wearable devices among adults with or at risk for cardiovascular disease (CVD) in the US population in 2019 to 2020.

Design, Setting, and Participants

This population-based cross-sectional study included a nationally representative sample of the US adults from the Health Information National Trends Survey (HINTS). Data were analyzed from June 1 to November 15, 2022.

Exposures

Self-reported CVD (history of heart attack, angina, or congestive heart failure) and CVD risk factors (≥1 risk factor among hypertension, diabetes, obesity, or cigarette smoking).

Main Outcomes and Measures

Self-reported access to wearable devices, frequency of use, and willingness to share health data with clinicians (referred to as health care providers in the survey).

Results

Of the overall 9303 HINTS participants representing 247.3 million US adults (mean [SD] age, 48.8 [17.9] years; 51% [95% CI, 49%-53%] women), 933 (10.0%) representing 20.3 million US adults had CVD (mean [SD] age, 62.2 [17.0] years; 43% [95% CI, 37%-49%] women), and 5185 (55.7%) representing 134.9 million US adults were at risk for CVD (mean [SD] age, 51.4 [16.9] years; 43% [95% CI, 37%-49%] women). In nationally weighted assessments, an estimated 3.6 million US adults with CVD (18% [95% CI, 14%-23%]) and 34.5 million at risk for CVD (26% [95% CI, 24%-28%]) used wearable devices compared with an estimated 29% (95% CI, 27%-30%) of the overall US adult population. After accounting for differences in demographic characteristics, cardiovascular risk factor profile, and socioeconomic features, older age (odds ratio [OR], 0.35 [95% CI, 0.26-0.48]), lower educational attainment (OR, 0.35 [95% CI, 0.24-0.52]), and lower household income (OR, 0.42 [95% CI, 0.29-0.60]) were independently associated with lower use of wearable devices in US adults at risk for CVD. Among wearable device users, a smaller proportion of adults with CVD reported using wearable devices every day (38% [95% CI, 26%-50%]) compared with overall (49% [95% CI, 45%-53%]) and at-risk (48% [95% CI, 43%-53%]) populations. Among wearable device users, an estimated 83% (95% CI, 70%-92%) of US adults with CVD and 81% (95% CI, 76%-85%) at risk for CVD favored sharing wearable device data with their clinicians to improve care.

Conclusions and Relevance

Among individuals with or at risk for CVD, fewer than 1 in 4 use wearable devices, with only half of those reporting consistent daily use. As wearable devices emerge as tools that can improve cardiovascular health, the current use patterns could exacerbate disparities unless there are strategies to ensure equitable adoption.

Effect modification by geographic area on the association between health literacy and self-rated health: a nationwide cross-sectional study in Japan

BACKGROUND

Health literacy (HL) has gained increasing attention as a factor related to health behaviors and outcomes. This study aimed to investigate geographic differences in HL levels and effect modification by geographic area on their relationship with self-rated health in the Japanese population using a nationwide sample.

METHODS

Data for this study were derived from a nationally representative cross-sectional survey on health information access for consumers in Japan using a mailed self-administered questionnaire in 2020 (INFORM Study 2020). Valid responses from 3,511 survey participants, selected using two-stage stratified random sampling, were analyzed in this study. HL was measured using the Communicative and Critical Health Literacy Scale (CCHL). Multiple regression and logistic regression analyses were conducted to examine the associations between geographic characteristics and HL and effect modification on the association between HL and self-rated health by geographic area, controlling for sociodemographic characteristics.

RESULTS

The mean HL score was 3.45 (SD = 0.78), somewhat lower compared with previous studies on the Japanese general population. HL was higher in Kanto area than in Chubu area, after controlling for sociodemographic factors and municipality size. Furthermore, HL was positively associated with self-rated health after controlling for sociodemographic and geographic factors; however, this association was more evident in eastern areas than in western areas.

CONCLUSION

The findings indicate geographic differences in HL levels and effect modification by geographic area on the relationship between HL and self-rated health in the general Japanese population. HL was more strongly associated with self-rated health in eastern areas than in western areas. Further investigation is needed to explore the moderating effects of areal features, including the distribution of primary care physicians and social capital, when formulating strategies to improve HL in different contexts.

Association Between the Use of Wearable Devices and Physical Activity Among US Adults With Depression and Anxiety: Evidence From the 2019 and 2020 Health Information National Trends Survey

Objective The objective of this study was to examine the relationship between wearable device (WD) use and physical activity (PA) levels among US adults with self-reported depression and anxiety. Methods Data were pooled from 2026 adults who self-reported depression and anxiety from the 2019 and 2020 Health Information National Trends Survey. The explanatory variable was WD use, and the outcomes were weekly PA levels and resistance strength training. Logistic regression was conducted to investigate the association between WD and PA parameters. Results About 33% of adults with self-reported depression/anxiety reported WD use. Only 32.5% and 34.2% of the population reported meeting the weekly recommended levels of physical activity (≥150 minutes/week) and strength and resistance exercise (≥2 times weekly), respectively. In adjusted analyses, the use of WD was not associated with meeting the national weekly recommendation for physical activity (OR 1.38, 95% CI (0.94, 2.04); p=0.10) or resistance strength training (OR 1.31, 95% CI (0.82, 2.08); p=0.26). Further exploratory analysis also showed that physical activity levels did not differ with the frequency of WD use. Conclusion Despite the popularity of WD use among people with mental disorders, we found that use of WD was not associated with increased physical activity measures, suggesting that although there is a promise for these tools to augment mental health, their real-world effectiveness in promoting physical activity in people with mental disorders remains to be proven.

Examining Disparities in Current E-Cigarette Use among U.S. Adults before and after the WHO Declaration of the COVID-19 Pandemic in March 2020

This paper aims to estimate the prevalence of e-cigarette use before and after the COVID-19 pandemic declaration and to delineate disparities in use across subpopulations. Data were derived from the 2020 Health Information National Trends Survey (N = 3865) to conduct weighted multivariable logistic regression and marginal analyses. The overall prevalence of current e-cigarette use increased from 4.79% to 8.63% after the COVID-19 pandemic declaration. Furthermore, non-Hispanic Black people and Hispanic people had lower odds of current e-cigarette use than non-Hispanic White people, but no significant differences were observed between groups before the pandemic. Compared to heterosexual participants, sexual minority (SM) participants had higher odds of current e-cigarette use after the declaration, with insignificant differences before. People who had cardiovascular disease conditions, relative to those without, had higher odds of current e-cigarette use after the declaration, but no group differences were found before the declaration. The marginal analyses showed that before and after the pandemic declaration, SM individuals had a significantly higher probability of using e-cigarettes compared to heterosexual individuals. These findings suggest the importance of adopting a subpopulation approach to understand and develop initiatives to address substance use, such as e-cigarettes, during pandemics and other public health emergencies.

Gender Differences in the Nonspecific and Health-Specific Use of Social Media Before and During the COVID-19 Pandemic: Trend Analysis Using HINTS 2017-2020 Data

The use of social media has changed since the outbreak of coronavirus disease 2019 (COVID-19). However, little is known about the gender disparity in social media use for nonspecific and health-specific issues before and during the COVID-19 pandemic. Based on a gender difference perspective, this study aimed to examine how the nonspecific and health-specific uses of social media changed in 2017-2020. The data came from the Health Information National Trends Survey Wave 5 Cycle 1-4. This study included 10,426 participants with complete data. Compared to 2017, there were higher levels of general use in 2019 and 2020, and an increased likelihood of health-related use in 2020 was reported among the general population. Female participants were more likely to be nonspecific and health-specific users than males. Moreover, the relationship of gender with general use increased in 2019 and 2020; however, concerning health-related use, it expanded in 2019 but narrowed in 2020. The COVID-19 global pandemic led to increased use of social media, especially for health-related issues among males. These findings further our understanding of the gender gap in health communication through social media, and contribute to targeted messaging to promote health and reduce disparities between different groups during the pandemic.

Relationship between mental health disorder symptoms and negative cancer perceptions among U.S. adults

PURPOSE

Although much emphasis has been placed on the impact of ambiguity on cognitive processes, the impact of mental health disorder symptoms and racial/ethnic disparities in cancer perception of fatalism and ambiguity remains less explored. This study explored the association between mental health disorder symptoms and negative cancer perceptions. Also, we assessed differences in these outcomes within mental health disorder symptoms and racial/ethnic subgroups to investigate the association between cancer perceptions and the other covariates within the aforementioned subgroups.

METHODS

We used the 2019-2020 Health Information National Trends Survey data (N = 9,303) to assess the perception of cancer fatalism and cancer communication ambiguity and employed weighted multivariable logistic regression to determine the effects of mental health disorder symptoms using the Patient Health Questionnaire-4 (PHQ-4) scale on these negative cancer perceptions among United States adults.

RESULTS

People with moderate [Adjusted Odds Ratio (AOR) = 1.58, 95% Confidence Interval (CI) = 1.09, 2.31] and severe anxiety/depression (AOR = 1.88, 95% CI = 1.12, 3.14) symptoms were more likely to have cancer fatalism perceptions than people with no anxiety/depression symptoms. People with mild (AOR = 1.33, 95% CI = 1.06, 1.69) or severe (AOR = 1.80, 95% CI = 1.03, 3.16) anxiety/depression symptoms were more likely to perceive cancer communication as ambiguous compared to people who had no anxiety/depression symptoms.

CONCLUSIONS

The study showed that mental health status was associated with both cancer fatalism and perceived cancer communication ambiguity. This suggests that interventions aimed at reducing mental health disorder symptoms may potentially reduce these negative perceptions, thereby improving participation in cancer prevention programs.

Chronic Diseases and Sociodemographic Characteristics Associated With Online Health Information Seeking and Using Social Networking Sites: Nationally Representative Cross-sectional Survey in Japan

BACKGROUND

In an aging society, worsening chronic diseases increase the burden on patients and the health care system. Using online health information including health information via social networking sites (SNSs), such as Facebook and YouTube, may play an important role in the self-management of chronic diseases and health promotion for internet users.

OBJECTIVE

This study aims to improve strategies for promoting access to reliable information for the self-management of chronic diseases via the internet, and to identify populations facing barriers to using the internet for health, we examined chronic diseases and characteristics associated with online health information seeking and the use of SNSs.

METHODS

This study used data from the INFORM Study 2020, which was a nationally representative cross-sectional postal mail survey conducted using a self-administered questionnaire in 2020. The dependent variables were online health information seeking and SNS use. Online health information seeking was assessed using 1 question about whether respondents used the internet to find health or medical information. SNS use was assessed by inquiring about the following 4 aspects: visiting SNSs, sharing health information on SNSs, writing in an online diary or blog, and watching a health-related video on YouTube. The independent variables were 8 chronic diseases. Other independent variables were sex, age, education status, work, marital status, household income, health literacy, and self-reported health status. We conducted a multivariable logistic regression model adjusted for all independent variables to examine the associations of chronic diseases and other variables with online health information seeking and SNS use.

RESULTS

The final sample for analysis comprised 2481 internet users. Hypertension or high blood pressure, chronic lung diseases, depression or anxiety disorder, and cancer were reported by 24.5%, 10.1%, 7.7%, and 7.2% of respondents, respectively. The odds ratio of online health information seeking among respondents with cancer was 2.19 (95% CI 1.47-3.27) compared with that among those without cancer, and the odds ratio among those with depression or anxiety disorder was 2.27 (95% CI 1.46-3.53) compared with that among those without. Further, the odds ratio for watching a health-related YouTube video among those with chronic lung diseases was 1.42 (95% CI 1.05-1.93) compared with that among those without these diseases. Women, younger age, higher level of education, and high health literacy were positively associated with online health information seeking and SNS use.

CONCLUSIONS

For patients with cancer, strategies for promoting access to websites with reliable cancer-related information as well as access among patients with chronic lung diseases to YouTube videos providing reliable information may be beneficial for the management of these diseases. Moreover, it is important to improve the online environment to encourage men, older adults, internet users with lower education levels, and those with low health literacy to access online health information.

The prevalence of metabolic conditions before and during the COVID-19 pandemic and its association with health and sociodemographic factors

BACKGROUND

There is a dearth of evidence on the relationship between COVID-19 and metabolic conditions among the general U.S. population. We examined the prevalence and association of metabolic conditions with health and sociodemographic factors before and during the COVID-19 pandemic.

METHODS

Data were drawn from the 2019 (N = 5,359) and 2020 (N = 3,830) Health Information National Trends Surveys on adults to compare observations before (2019) and during (2020) the COVID-19 pandemic. We conducted weighted descriptive and multivariable logistic regression analyses to assess the study objective.

RESULTS

During the pandemic, compared to pre-pandemic, the prevalence of diabetes (18.10% vs. 17.28%) has increased, while the prevalence of hypertension (36.38% vs. 36.36%) and obesity (34.68% vs. 34.18%) has remained similar. In general, the prevalence of metabolic conditions was higher during the pandemic (56.09%) compared to pre-pandemic (54.96%). Compared to never smokers, former smokers had higher odds of metabolic conditions (AOR = 1.38, 95% CI = 1.01, 1.87 and AOR = 1.57, 95% CI = 1.10, 2.25) before and during the pandemic, respectively. People with mild anxiety/depression symptoms (before: AOR = 1.52, 95% CI = 1.06, 2.19 and during: AOR = 1.55, 95% CI = 1.01, 2.38) had higher odds of metabolic conditions relative to those with no anxiety/depression symptoms.

CONCLUSION

This study found increased odds of metabolic conditions among certain subgroups of US adults during the pandemic. We recommend further studies and proper allocation of public health resources to address these conditions.

U.S. Adults' Public Opinion Toward R-Rating Labels for Movies With Cigarette Smoking

INTRODUCTION

The purpose of this study was to describe the proportion of U.S. adults who support, oppose, or are neutral toward a policy designating R-ratings for movies depicting cigarette smoking and to identify predictors of policy opposition or neutrality among a nationally representative sample.

METHODS

Data from the 2020 Health Information National Trends Survey 5 Cycle 4 (fielded in 2020; N=3,865) were used to estimate the prevalence of support, neutrality, and opposition to a policy designating R-ratings for movies containing depictions of cigarette smoking. Weighted, multivariable logistic regression was used to assess the predictors of policy opposition or neutrality.

RESULTS

The analysis showed that 47.0% of U.S. adults were supportive, 20.3% opposed, and 30.3% were neutral toward designating R-ratings for movies depicting cigarette smoking. Older adults were significantly less likely to be neutral to or opposed to an R-rating policy than adults aged 18-34 years: age 50-64 years (OR=0.56; 95% CI=0.35, 0.87), age 65-74 years (OR=0.39; 95% CI=0.24, 0.64), and age ≥75 years (OR=0.27; 95% CI=0.16, 0.45). In addition, non-Hispanic Asians were significantly less likely than non-Hispanic Whites to be neutral to or opposed the policy (OR=0.46; 95% CI=0.25, 0.84).

CONCLUSIONS

Study findings show that a near majority of U.S. adults support a policy that would designate R-ratings for movies depicting cigarette smoking and that there is greater neutrality than opposition toward the policy. Assessing public opinion toward a policy designating R-ratings for movies depicting cigarette smoking may inform efforts to educate the public about the value of such policies for preventing youth tobacco initiation.

Association between E-Cigarette Use Behaviors and Anxiety/Depression among Black/African American Adults Based on Sexual Identity

Limited studies have examined disparities in e-cigarette use among Black/African American adults by sexual identity and whether the relationship between symptoms of anxiety/depression and e-cigarette use varies by sexual identity. We examined the association between e-cigarette use behaviors (never, former, and current use) and anxiety/depression among a nationally representative sample of Black/African American adults who identified as a sexual minority (lesbian/gay, bisexual, and others) or heterosexual individuals. We combined cross-sectional data from the 2011 to 2020 Health Information National Trends Survey (n = 6267), which is a nationally representative data set. We computed weighted e-cigarette use prevalence and multinomial logistic regression results (never use compared with former and current use, respectively). Among Blacks/African Americans, a larger percentage of sexual minority individuals compared with heterosexual individuals reported former and current e-cigarette use. Among sexual minorities, lesbian/gay individuals reported higher former e-cigarette use, whereas bisexual individuals reported higher current e-cigarette use. Among sexual minority individuals, moderate symptoms of anxiety/depression, compared with no symptoms of anxiety/depression, were associated with a higher likelihood of former e-cigarette use. Among heterosexuals, moderate symptoms of anxiety/depression were also associated with a higher likelihood of former e-cigarette use, while mild and severe symptoms of anxiety/depression were associated with current e-cigarette use compared with no symptoms of anxiety/depression. The intersection between sexual identity and anxiety/depression influenced e-cigarette use behaviors in different ways among Black/African Americans. The findings reinforce the heterogeneity within the Black/African American population, indicating the dangers of not considering subgroup differences as a standard part of public health research practice.

The Impact of Patient-Centered Care on Cancer Patients' QOC, Self-Efficacy, and Trust Towards Doctors: Analysis of a National Survey

Patient-centered approaches impact cancer patients' perceptions and outcomes in different ways. This study explores the impact of patient-centered care practices on cancer patients' quality-of-care (QOC), self-efficacy, and trust in their doctors. We utilized cross-sectional national survey data from the National Cancer Institute collected between 2017 and 2020. All estimates were weighted using the jackknife method. We used multivariable logistic regression to test our hypotheses adjusted for the demographics of the 1932 cancer patients that responded to the survey. Findings indicate that patient-centered communication resulted in better QOC, self-efficacy, and trust in doctors. In addition, engagement in their care improved patients' trust in cancer-related information received from doctors. QOC and patients' trust in doctors were significantly improved with the patients' understanding of the next steps, addressing feelings, clear explanation of the problems, spending enough time with the clinicians, addressing uncertainty, and involvement in decisions. Patients who were given a chance to ask questions were significantly more likely to trust their doctors. Technology use did not impact any of these interactions. Patient-centered strategies should consider the needs of the patients in the cancer settings to improve overall outcomes. Organizations should also build strategies that are goal-oriented and centered around the patients' needs, as standard strategies cannot induce the wanted results.

Trends and differences in perceptions of patient-centered communication among adults in the US

OBJECTIVE

Patient-centered communication (PCC) is a key indicator of healthcare quality and is critical to patient-centered care. The purpose of this study is to examine the trends in PCC over the past decade and determine if differences in PCC by subpopulation remain METHODS: We used nationally representative survey data from the Health Information National Trends Study (HINTS) to examine PCC. We conducted trend and multivariate regression analyses to understand the changes of PCC scores and differences in PCC by key sociodemographic groups.

RESULTS

PCC reported among adults minimally increased with the largest increases in participants involved in making decisions regarding their healthcare. Participants who were non-Hispanic Black, older, had less than a high school education, or rural residents reported more positive perceptions of PCC CONCLUSION: Our findings indicate improvements to PCC over time. These findings also indicate that differences in patients' perceptions of PCC continue to persist and it's possible that personal expectations may influence a person's perception of the quality of PCC experienced PRACTICE IMPLICATIONS: This study highlights the continued need for provider education in patient emotional support and providing patients with the skills and resources to engage in high quality PCC.

Association of multimorbidity with the use of health information technology

Objective

To examine the association of multimorbidity with health information technology use among adults in the USA.

Methods

We used cross-sectional study design and data from the Health Information National Trends Survey 5 Cycle 4. Health information technology use was measured with ten variables comprising access, recent use, and healthcare management. Unadjusted and adjusted logistic and multinomial logistic regressions were used to model the associations of multimorbidity with health information technology use.

Results

Among adults with multimorbidity, health information technology use for specific purposes ranged from 37.8% for helping make medical decisions to 51.7% for communicating with healthcare providers. In multivariable regressions, individuals with multimorbidity were more likely to report general use of health information technology (adjusted odds ratios  =  1.48, 95% confidence intervals  =  1.01-2.15) and more likely to use health information technology to check test results (adjusted odds ratios  =  1.85, 95% confidence intervals  =  1.33-2.58) compared to adults with only one chronic condition, however, there were no significant differences in other forms of health information technology use. We also observed interactive associations of multimorbidity and age on various components of health information technology use. Compared to younger adults with multimorbidity, older adults (≥ 65 years of age) with multimorbidity were less likely to use almost all aspects of health information technology.

Conclusion

Health information technology use disparities by age and multimorbidity were observed. Education and interventions are needed to promote health information technology use among older adults in general and specifically among older adults with multimorbidity.

Association between COVID-19 pandemic declaration and depression/anxiety among U.S. adults

BACKGROUND

Although studies have investigated the impact of the COVID-19 on mental health, few studies have attempted to compare the prevalence of depression/anxiety symptoms among U.S. adults before and after the COVID-19 pandemic declaration. We examined the prevalence and association between depression/anxiety symptoms and COVID-19 pandemic declaration among U.S. adult population and subgroups.

METHODS

A nationally representative cross-sectional study of the Health Information National Trends Survey (HINTS 5, Cycle 4) assessing health-related information and behaviors in U.S. adults aged ≥18 years from February through June 2020. The primary dependent variable was current depression/anxiety derived from Patient Health Questionnaire-4. The main independent variable was responses before and after the COVID-19 pandemic declaration in addition to sexual identity heterosexual identity, /race/ethnicity and rural-urban commuting areas. Covariates were sociodemographic factors, and health risk behaviors. Weighted percentages, multivariable logistic regression, and Chi-square tests were used to establish the prevalence and association between current depression/anxiety and the independent variables and covariates.

RESULTS

A total of 3,865 participants completed the survey and included 35.3% of the participants before the COVID-19 pandemic declaration. Most of the sample were aged 50-64 years [33.0%]; males [51.0%]; and non-Hispanic Whites [70.1%]). The post-pandemic declaration included participants, aged 35-49 years [27.0%]; females [52.6%]; and non-Hispanic Whites [59.6%]). The prevalence of depression/anxiety was higher after the COVID-19 pandemic declaration (32.2%) than before the declaration (29.9%). Higher risks of depression/anxiety symptoms after the declaration were associated with being a sexual minority ([adjusted odds ratio] AOR, 2.91 [95% confidence interval (CI), 1.38-6.14]) and having fair/poor general health (AOR, 2.91 [95% CI, 1.76-4.83]). The probability of experiencing depression/anxiety symptoms after the declaration was highest among homosexuals/lesbians/gays (65.6%) compared to bisexuals (39.6%), and heterosexuals (30.1%).

CONCLUSIONS

In this study, young adults, non-Hispanic Whites, and those with fair/poor general health had a higher burden of depression/anxiety symptoms after the pandemic declaration. The development of psychological support strategies to promote wellbeing during the pandemic may reduce psychological distress in the population, especially among at-risk populations.

Clinical Cancer and Direct-to-Consumer Genetic Test Result-Sharing Behavior: Findings from HINTS 2020

INTRODUCTION

Sharing genetic test results with different stakeholders such as family members, healthcare providers and genetic counselors (HCP/GCs), spouses/partners, and friends is a health behavior of clinical importance in genomic medicine.

METHODS

Using nationally representative population-based data collected from the Health Information National Trends Survey (HINTS 5, cycle 4), we identified the prevalence and factors associated with genetic test result-sharing behavior for high-risk cancer tests, genetic health risk tests, and ancestry tests within four groups: HCP/GCs, first-degree relatives (FDRs), spouse/partner, and friend/other.

RESULTS

Overall, 68.4% of those who underwent high-risk cancer genetic testing shared their results with FDRs, whereas 89.9% shared with HCP/GCs. In adjusted multivariable analyses, women were nine times more likely than men to share (p = 0.006), and those with a personal history of cancer were less likely to share with HCP/GCs (OR = 0.025, p ≤ 0.001). Of those tested for genetic health risk, 66.5% shared with HCP/GCs, 38.7% with FDRs, 66.6% with a spouse/partner, 12.8% with a friend, and 14.1% did not share results with anyone. Of those who underwent ancestry testing, very few shared results with HCP/GCs (2.6%), whereas modest sharing was reported with FDRs, spouses/partners, and friends.

DISCUSSION

These data add empirical evidence about the population prevalence of genetic information sharing and serve as a metric for public engagement with genetic testing.

Influence of Cost-Related Considerations on Clinical Trial Participation: Results from the 2020 Health Information National Trends Survey (HINTS)

BACKGROUND

People experiencing financial burden are underrepresented in clinical trials.

OBJECTIVE

Describe the prevalence of cost-related considerations influential to trial participation and their associations with person-level characteristics.

DESIGN

This cross-sectional study used and assessed how three cost-related considerations would influence the decision to participate in a hypothetical clinical trial.

PARTICIPANTS

A total of 3682 US adult respondents to the Health Information National Trends Survey MAIN MEASURES: Survey-weighted multivariable logistic regression estimated associations between respondent characteristics and odds of reporting cost-related considerations as very influential to participation.

KEY RESULTS

Among 3682 respondents, median age was 48 (IQR 33-61). Most were non-Hispanic White (60%), living comfortably or getting by on their income (74%), with ≥ 1 medical condition (61%). Over half (55%) of respondents reported at least one cost-related consideration as very influential to trial participation, including if usual care was not covered by insurance (reported by 42%), payment for participation (24%), or support for participation (24%). Respondents who were younger (18-34 vs. ≥ 75, adjusted odds ratio [aOR] 4.3, 95% CI 2.3-8.1), more educated (high school vs. <high school, aOR 2.1, 95% CI 1.1-4.1), or with lower perceived income (having difficulty vs. living comfortably, aOR 2.1, 95% CI 1.1-3.8) had higher odds of reporting any cost-related consideration as very influential to trial participation. Non-Hispanic Black vs. non-Hispanic White respondents had 29% lower odds (95% CI 0.5-0.9) of reporting any cost-related consideration as very influential to trial participation.

CONCLUSIONS

Cost-related considerations would influence many individuals' decisions to participate in a clinical trial, though prevalence of these concerns differed by respondent characteristics. Reducing financial barriers to trial participation may promote equitable trial access and greater trial enrollment diversity.

A Comparison of Women's and Men's Online Information Seeking Behaviors about Gender-Related Health Information: A German Stratified Online Survey (Preprint)

BACKGROUND

Gender-sensitive approaches to health communication aim to integrate gender perspectives at all levels of communication, as an individual's biological sex and socially assigned gender identity have an impact on whether and how one acquires what type of health information. Due to the fast and low-cost opportunity to search for a wide range of information, the internet seems to be a particularly suitable place for gender-related health information about diseases of sex-specific organs and diseases where biological differences are associated with different health risks.

OBJECTIVE

This study aims to inform gender-related information provision and acquisition in 2 ways. The first objective was to provide a theory-driven analysis of web-based health information-seeking behavior (HISB) regarding gender-related issues. Therefore, the Planned Risk Information Seeking Model (PRISM), which is one of the most integrative models of HISB, was adapted and applied. Second, we asked for gender-specific motivational determinants of gender-related web-based HISB comparing the predictors in the groups of women and men.

METHODS

Data from a stratified web-based survey of the German population (N=3000) explained gender-related web-based HISB and influencing patterns comparing women and men. The applicability of PRISM to gender-related web-based HISB was tested using structural equation modeling and a multigroup comparison.

RESULTS

The results revealed PRISM as an effective framework for explaining gender-related web-based HISB. The model accounted for 28.8% of the variance in gender-related web-based HISB. Gender-related subjective norms provided the most crucial explanatory power, followed by perceived seeking control. The multigroup comparison revealed differences in the model's explanatory power and the relevance of predictors of gender-related web-based HISB. The share of explained variances of web-based HISB is higher in men than in women. For men, norms were a more relevant promoting factor, whereas web-based HISB of women was more strongly associated with perceived seeking control.

CONCLUSIONS

The results are crucial for gender-sensitive targeting strategies and suggest gender-related health information interventions that address gender-related subjective norms. Furthermore, programs (eg, web-based learning units) should be developed and offered to improve individuals' (perceived) abilities to perform web-based searches for health information, as those with higher control beliefs are more likely to access web-based information.

Assessment of anxiety/depression among cancer patients before and during the COVID-19 pandemic

OBJECTIVE

To assess differences in the prevalence of anxiety/depression symptoms among cancer patients before (2019) and during the COVID-19 pandemic (2020); and the associations between anxiety/depression and sociodemographic and health behavior factors among cancer patients before and during the pandemic.

METHODS

We analyzed data from the 2019 (n = 856) and 2020 (n = 626) Health Information National Trends Survey, a nationally representative survey of United States adults aged ≥18 years. Only adults with a cancer diagnosis were used in the analyses. Anxiety/depression was assessed using the Patient Health Questionnaire-4 (low/none [0-2], mild [3-5], moderate [6-8], and severe [9-12]) and dichotomized as low/none and current anxiety/depression (mild/moderate/severe). Multivariate analysis was performed.

RESULTS

The prevalence of anxiety/depression symptoms among cancer patients was 32.7% before the COVID-19 pandemic and 31.1% during the pandemic. The odds of anxiety/depression among patients with fair/poor health status was higher during the pandemic relative to before (before: odds ratio [OR] = 1.85 vs. during: OR = 3.89). Participants aged 50-64 years (before: OR = 0.29, 95% confidence interval [95% CI] = 0.11-0.76; during: OR = 0.33, 95% CI = 0.11-0.97) and ≥65 years (before: OR = 0.13, 95% CI = 0.05-0.34; during: OR = 0.18, 95% CI = 0.07-0.47) had lower odds of anxiety/depression before and during the pandemic compared to those aged 35-49 years. Hispanics/Latinos had higher odds of anxiety/depression (OR = 2.70, 95% CI = 1.11-6.57) before the pandemic and lower odds of anxiety/depression during the pandemic (OR = 0.2, 95% CI = 0.05-1.01) compared to non-Hispanic Whites. Those who completed high school (before: OR = 0.08, 95% CI = 0.01-0.42), some college (before: OR = 0.10, 95% CI = 0.02-0.42), ≥college degree had lower odds of anxiety/depression symptoms (before: OR = 0.05, 95% CI = 0.01-0.26; during: OR = 0.06, 95% CI = 0.01-0.61) compared to those with less than a high school education.

CONCLUSION

Our results suggest the need to increase the provision of mental health services to cancer patients at high risk of developing anxiety/depression symptoms, particularly during public health emergencies, to alleviate further health burdens.

Awareness of Alcohol and Cancer Risk and the California Proposition 65 Warning Sign Updates: A Natural Experiment

In 1986, California enacted Proposition 65 (P65), requiring businesses to display warning signs informing consumers that specific chemicals and alcohol exposure increase the risk of cancer and reproductive harm. In 2018, the P65 alcohol warning signs were updated to include an informational P65 website link, and the update was associated with media coverage and increased enforcement of warning requirements. This study examines knowledge of the association between alcohol use and cancer risk in California compared to the rest of the US before and after the 2018 P65 update. We analyzed state-level data on alcohol and cancer knowledge from the Health Information National Trends Survey from 2017 (n = 3285), 2019 (n = 5438), and 2020 (n = 3865). We performed multinomial logistic regressions to examine knowledge levels by survey year and location (California vs. all other states) and reported the predicted marginals of knowledge by survey year and location. The adjusted prevalence of respondents who reported an association between alcohol and cancer risk was higher in California (41.6%) than the remaining states (34.1%) (p = 0.04). However, knowledge levels decreased significantly over survey years, and there was no evidence for an effect of the P65 update on knowledge in California compared to other states based on the testing of an interaction between state and year (p = 0.32). The 1986 warning signs may have had an enduring effect on awareness, though the update, so far, has not. Further efforts are needed to determine how to increase alcohol and cancer knowledge to address the burden of alcohol-attributable cancers.

Expanding the Health Information National Trends Survey Research Program Internationally to Examine Global Health Communication Trends: Comparing Health Information Seeking Behaviors in the U.S. and Germany

The Health Information National Trends Survey (HINTS) is a well-established U.S.-based research program administered by the National Cancer Institute to track the public access to and use of health information. This paper introduces a German research initiative, part of the International Studies to Investigate Global Health Information Trends (INSIGHTS) research consortium. This adaptation of the HINTS is important for initiating analyses of global health communication practices and comparing health information seeking behaviors (HISB) across nations to pinpoint potentials and challenges of health information provision and contribute to a deeper understanding of socio-contextual determinants of HISB. First cross-country comparisons revealed that the share of residents seeking for health information is high in the U.S. (80%) and Germany (74%), but different primary sources are used. Whereas a clear majority of U.S. residents chose the Internet to gather health information (74.9%), Germans most often turn to health professionals (48.0%). Socio-structural and health(care)-related predictors were found to contribute to the explanation of HISB in both countries, whereas information-related predictors were only relevant in Germany. The results indicate the need to engage in patient-provider communication to initiate HISB and to improve the access to information for residents with lower socio-economic backgrounds.