1
|
Melkonian SC, Jim MA, Reza A, Peipins LA, Haverkamp D, Said N, Sharpe JD. Incidence of Stomach, Liver, and Colorectal Cancers by Geography and Social Vulnerability Among American Indian and Alaska Native Populations, 2010-2019. Am J Epidemiol 2024; 193:58-74. [PMID: 37823258 PMCID: PMC10990004 DOI: 10.1093/aje/kwad194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 07/12/2023] [Accepted: 10/05/2023] [Indexed: 10/13/2023] Open
Abstract
Social determinants of health and associated systems, policies, and practices are important drivers of health disparities. American Indian and Alaska Native (AI/AN) populations in the United States have elevated incidence rates of stomach, liver, and colorectal cancers compared with other racial/ethnic groups. In this study, we examined incidence rates of 3 types of gastrointestinal cancer among non-Hispanic AI/AN (NH-AI/AN) and non-Hispanic White (NHW) populations by geographic region and Social Vulnerability Index (SVI) score. Incident cases diagnosed during 2010-2019 were identified from population-based cancer registries linked with the Indian Health Service patient registration databases. Age-adjusted incidence rates (per 100,000 population) for stomach, liver, and colorectal cancers were compared within NH-AI/AN populations and between the NH-AI/AN and NHW populations by SVI score. Rates were higher among NH-AI/AN populations in moderate- and high-SVI-score counties in Alaska, the Southern Plains, and the East than in low-SVI counties. Incidence rates among NH-AI/AN populations were elevated when compared with NHW populations by SVI category. Results indicated that higher social vulnerability may drive elevated cancer incidence among NH-AI/AN populations. Additionally, disparities between NH-AI/AN and NHW populations persist even when accounting for SVI. Exploring social vulnerability can aid in designing more effective interventions to address root causes of cancer disparities among AI/AN populations.
Collapse
Affiliation(s)
- Stephanie C. Melkonian
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, New Mexico, United States (Stephanie C. Melkonian, Melissa A. Jim, Donald Haverkamp); Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, United States (Avid Reza, Lucy A. Peipins); University of Chicago, Chicago, Illinois, United States (Nathania Said); and Geospatial Research, Analysis, and Services Program, Agency for Toxic Substances and Disease Registry, Atlanta, Georgia, United States (J. Danielle Sharpe)
| | - Melissa A. Jim
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, New Mexico, United States (Stephanie C. Melkonian, Melissa A. Jim, Donald Haverkamp); Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, United States (Avid Reza, Lucy A. Peipins); University of Chicago, Chicago, Illinois, United States (Nathania Said); and Geospatial Research, Analysis, and Services Program, Agency for Toxic Substances and Disease Registry, Atlanta, Georgia, United States (J. Danielle Sharpe)
| | - Avid Reza
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, New Mexico, United States (Stephanie C. Melkonian, Melissa A. Jim, Donald Haverkamp); Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, United States (Avid Reza, Lucy A. Peipins); University of Chicago, Chicago, Illinois, United States (Nathania Said); and Geospatial Research, Analysis, and Services Program, Agency for Toxic Substances and Disease Registry, Atlanta, Georgia, United States (J. Danielle Sharpe)
| | - Lucy A. Peipins
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, New Mexico, United States (Stephanie C. Melkonian, Melissa A. Jim, Donald Haverkamp); Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, United States (Avid Reza, Lucy A. Peipins); University of Chicago, Chicago, Illinois, United States (Nathania Said); and Geospatial Research, Analysis, and Services Program, Agency for Toxic Substances and Disease Registry, Atlanta, Georgia, United States (J. Danielle Sharpe)
| | - Donald Haverkamp
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, New Mexico, United States (Stephanie C. Melkonian, Melissa A. Jim, Donald Haverkamp); Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, United States (Avid Reza, Lucy A. Peipins); University of Chicago, Chicago, Illinois, United States (Nathania Said); and Geospatial Research, Analysis, and Services Program, Agency for Toxic Substances and Disease Registry, Atlanta, Georgia, United States (J. Danielle Sharpe)
| | - Nathania Said
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, New Mexico, United States (Stephanie C. Melkonian, Melissa A. Jim, Donald Haverkamp); Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, United States (Avid Reza, Lucy A. Peipins); University of Chicago, Chicago, Illinois, United States (Nathania Said); and Geospatial Research, Analysis, and Services Program, Agency for Toxic Substances and Disease Registry, Atlanta, Georgia, United States (J. Danielle Sharpe)
| | - J. Danielle Sharpe
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, New Mexico, United States (Stephanie C. Melkonian, Melissa A. Jim, Donald Haverkamp); Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, United States (Avid Reza, Lucy A. Peipins); University of Chicago, Chicago, Illinois, United States (Nathania Said); and Geospatial Research, Analysis, and Services Program, Agency for Toxic Substances and Disease Registry, Atlanta, Georgia, United States (J. Danielle Sharpe)
| |
Collapse
|
2
|
Flórez KR, Day SE, Huang TTK, Konty KJ, D'Agostino EM. Latino Children's Obesity Risk Varies by Place of Birth: Findings from New York City Public School Youth, 2006-2017. Child Obes 2022; 18:291-300. [PMID: 34788125 PMCID: PMC9248336 DOI: 10.1089/chi.2021.0056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Introduction: Research showing that place of birth (POB) predicts excess weight gain and obesity risk among Latino adults has not prompted similar research in Latino children, although childhood is a critical period for preventing obesity. Objective: To identify differences in obesity risk among Latino children by POB. Methods: Longitudinal cohort observational study on public school children self-identified by parent/guardian as Latino in grades K-12 for school years 2006-07 through 2016-17 with measured weight and height (n = 570,172students; 3,103,642observations). POB reported by parent/guardian was categorized as continental United States [not New York City (NYC)] (n = 295,693), NYC (n = 166,361), South America (n = 19,452), Central America (n = 10,241), Dominican Republic (n = 57,0880), Puerto Rico (n = 9687), and Mexico (n = 9647). Age- and sex-specific BMI percentiles were estimated based on established growth charts. Data were analyzed in 2020. Results: Prevalence of obesity was highest among US (non-NYC)-born girls (21%) and boys (27%), followed by NYC-born girls (19%) and boys (25%). Among girls, South Americans (9%) had the lowest prevalence of all levels of obesity, while Puerto Ricans (19%) and Dominicans (15%) had the highest prevalence. Among boys, South Americans also had the lowest prevalence of all levels of obesity (15%), while Puerto Ricans (22%) and Mexicans (21%) had the highest. In adjusted models, obesity risk was highest in US (non-NYC)-born children, followed by children born in NYC (p < 0.001). Immigrant Latino children exhibited an advantage even after controlling for individual and neighborhood sociodemographic features, particularly Dominicans, South Americans, and Puerto Ricans. Conclusions: The heterogeneity of obesity risk among Latino children highlights the importance of POB.
Collapse
Affiliation(s)
- Karen R. Flórez
- Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA.,Address correspondence to: Karen R. Flórez, DrPH, Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York, 55 West 125th Street, New York, NY 10027, USA
| | - Sophia E. Day
- NYC Department of Health and Mental Hygiene, Office of School Health, Queens, NY, USA
| | - Terry T.-K. Huang
- Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Kevin J. Konty
- NYC Department of Health and Mental Hygiene, Office of School Health, Queens, NY, USA
| | - Emily M. D'Agostino
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA
| |
Collapse
|
3
|
Mandelbaum J, Harrison SE, Brittingham J. Disparities in Nutrition Counseling at Pediatric Wellness Visits in South Carolina. Child Obes 2020; 16:520-526. [PMID: 32960095 DOI: 10.1089/chi.2020.0025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: In 2007, an Expert Committee recommended that dietary patterns be assessed at each wellness visit and that counseling on diet and nutrition be provided to all children. Few studies have examined the "uptake" of obesity prevention practices into pediatric primary care. This study aimed to describe patterns of nutrition counseling among children at wellness visits in South Carolina between 2008 and 2017 and determine whether sociodemographic disparities existed. Methods: The sample included 123,864 children 2-18 years of age who had a wellness visit at one of South Carolina's four major health care systems between January 1, 2008, and December 31, 2017. Documentation of nutrition counseling was defined by the International Classification of Diseases (ICD)-9/10 codes. A matched sample design and conditional logistic regression were used to examine sociodemographic disparities in children who did and did not receive nutrition counseling. Results: Nutrition counseling was documented at 3.55% of wellness visits. Significant sociodemographic disparities were found, including that African American and Hispanic children were less likely to receive counseling than white or non-Hispanic children. Differences were also found by urban/rural residence, health insurance, and BMI. Despite guidelines, ICD 9/10 code indicating diagnosis of overweight or obesity was documented for only 12.2% of children. Conclusions: Nutrition counseling was rarely documented in a large sample of electronic medical record (EMR) data from pediatric wellness visits in South Carolina-a state heavily burdened by childhood obesity. Children's BMIs were infrequently recorded, which may be a barrier to tracking BMI over time. Sociodemographic and geographic differences in nutrition counseling may exacerbate disparities in childhood obesity.
Collapse
Affiliation(s)
- Jennifer Mandelbaum
- SC SmartState Center for Healthcare Quality, Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Sayward E Harrison
- SC SmartState Center for Healthcare Quality, Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.,Department of Psychology, College of Arts and Sciences, University of South Carolina, Columbia, SC, USA
| | | |
Collapse
|
6
|
Talavera JO, Rivas-Ruiz R, Pérez-Rodríguez M, Roy-Garcia IA, Palacios-Cruz L. De vuelta a la clínica: sin justificación no existe pregunta de investigación que valga. GAC MED MEX 2019; 155:168-175. [PMID: 31056591 PMCID: PMC7446752 DOI: 10.24875/gmm.19004942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 01/16/2019] [Indexed: 12/12/2022] Open
Abstract
A clinical research question requires the concurrence of clinical experience and knowledge on methodology and statistics in that who formulates it. Initially, a research question should have a structure that clearly establishes what is that which is being sought (consequence or outcome), in whom (baseline status), and by action of what (maneuver). Subsequently, its reasoning must explore four aspects: feasibility and reasonableness of the questioning, lack of a prior answer, relevance of the answer to be obtained, and applicability. Once these aspects are satisfactorily covered, the question can be regarded as being "clinically relevant", which is different from being statistically significant, which refers to the probability of the result being driven by chance, which does not reflect the relevance of the question or the outcome. One should never forget that every maneuver entails adverse events that, when serious, discredit good results. It is imperative to have the possible answer estimated from within the structure of the question. The function of clinical research is to corroborate or reject a hypothesis, rather than to empirically test to find out what the outcome is.
Collapse
Affiliation(s)
- Juan O Talavera
- Dirección de Enseñanza e Investigación, Centro Médico ABC. Ciudad de México, México
| | - Rodolfo Rivas-Ruiz
- Instituto Mexicano del Seguro Social, Coordinación de Investigación en Salud, Centro Médico Nacional Siglo XXI, Centro de Adiestramiento en Investigación Clínica. Ciudad de México, México
| | - Marcela Pérez-Rodríguez
- Instituto Mexicano del Seguro Social, Coordinación de Investigación en Salud, Centro Médico Nacional Siglo XXI, Centro de Adiestramiento en Investigación Clínica. Ciudad de México, México
| | - Ivonne Analí Roy-Garcia
- Instituto Mexicano del Seguro Social, Coordinación de Investigación en Salud, Centro Médico Nacional Siglo XXI, Centro de Adiestramiento en Investigación Clínica. Ciudad de México, México
| | - Lino Palacios-Cruz
- Secretaría de Salud, Instituto Nacional de Psiquiatría "Dr. Ramón de la Fuente", Subdirección de Investigaciones Clínicas, Departamento Epidemiología Clínica. Ciudad de México, México
| |
Collapse
|
7
|
Kumanyika SK. Supplement overview: what the Healthy Communities Study is telling us about childhood obesity prevention in U.S. communities. Pediatr Obes 2018; 13 Suppl 1:3-6. [PMID: 30345706 DOI: 10.1111/ijpo.12478] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 08/21/2018] [Indexed: 12/01/2022]
Abstract
The Healthy Communities Study (HCS), conducted between 2010 and 2016, tells a real-world story of how childhood obesity prevention efforts have unfolded in 130 U.S. communities. The study documented nearly 10,000 current and past community policies and programs (CPPs) and assessed dietary and physical activity behaviors, weight, height, and waist circumference of more than 5,000, 4- to 15-year-old children. The articles in this HCS supplement describe the variables created to characterize the CPPs, CPP relationships with children's behavioral and weight status, other analyses of interest, and recruitment challenges. Findings suggest that many of the strategies being implemented work as intended to improve children's behaviors and weight status. However, of concern, findings also indicate lesser reach to children in demographic groups at highest risk of obesity. Overall, the HCS insights can guide the next phase of efforts to strengthen existing CPPs and motivate other, novel approaches to combating childhood obesity.
Collapse
Affiliation(s)
- S K Kumanyika
- Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| |
Collapse
|