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Lyons K, Schmid KK, Ratnapradipa KL, Tibbits M, Watanabe-Galloway S. Comparing bullying to ACEs in the national survey of children's health: Examining 2016-2019 prevalence trends among children and adolescents. Child Abuse Negl 2024; 151:106733. [PMID: 38507921 DOI: 10.1016/j.chiabu.2024.106733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 02/20/2024] [Accepted: 03/04/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVES To estimate adverse childhood experience (ACE) prevalence among children and adolescents aged 6-17 years in the United States, to examine factors influencing the prevalence of ACEs over the time period 2016-2019, and to examine the difference in bullying trends compared to ACEs in the NSCH. PARTICIPANTS AND SETTING The National Survey of Children's Health (NSCH) is a cross-sectional survey. Participants included respondents who completed the separate surveys for ages 6-11 and 12-17 from 2016 to 2019. METHODS Cumulative ACEs were analyzed to determine the change in prevalence of having at least one ACE, overall and stratified by age group. RESULTS Overall prevalence was highest among income difficulties (16-26 %); parent/guardian divorced or separated (29-31 %); and bullying (21-48 %). There was a significant time trend for income difficulties (decreased; p < 0.001), lived with anyone with a mental illness (increased; p = 0.004), racial/ethnic mistreatment (increased; p = 0.004), and bullying (increased; p < 0.001). Cumulative prevalence trends without bullying decreased significantly from 2016 to 2019 while prevalence trends for bullying increased significantly during this time frame. Sex, age, and race/ethnicity were significantly associated with some of the ACEs. CONCLUSIONS Trend of ACEs varies as prevalence of some ACEs increased while decreasing for others over time. Also, ACEs appear to affect children and adolescents differently according to sex, age group, and racial/ethnic background, which warrants the need to prioritize efforts to decrease the exposure to ACEs.
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Affiliation(s)
- Kiara Lyons
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE 68198-4395, United States of America; Maternal and Child Health Translational Research Team, College of Health Solutions, Arizona State University, 850 N. 5th St., Phoenix, AZ 85004, United States of America..
| | - Kendra K Schmid
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, 984375 Nebraska Medical Center, Omaha, NE 68198-4375, United States of America
| | - Kendra L Ratnapradipa
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE 68198-4395, United States of America
| | - Melissa Tibbits
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, 986075 Nebraska Medical Center, Omaha, NE 68198-6075, United States of America
| | - Shinobu Watanabe-Galloway
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE 68198-4395, United States of America
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Ratnapradipa KL, Wang R, Kabayundo J, Marquez Lavenant W, Nelson E, Ahuja M, Zhang Y, Wang H. Cross-sectional analysis of primary care clinics' policies, practices, and availability of patient support services during the COVID-19 pandemic. BMC Health Serv Res 2024; 24:279. [PMID: 38443959 PMCID: PMC10916250 DOI: 10.1186/s12913-024-10660-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/30/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Healthcare accessibility and utilization are important social determinants of health. Lack of access to healthcare, including missed or no-show appointments, can have negative health effects and be costly to patients and providers. Various office-based approaches and community partnerships can address patient access barriers. OBJECTIVES (1) To understand provider perceptions of patient barriers; (2) to describe the policies and practices used to address late or missed appointments, and (3) to evaluate access to patient support services, both in-clinic and with community partners. METHODS Mailed cross-sectional survey with online response option, sent to all Nebraska primary care clinics (n = 577) conducted April 2020 and January through April 2021. Chi-square tests compared rural-urban differences; logistic regression of clinical factors associated with policies and support services computed odds ratios (OR) and 95% confidence intervals (CI). RESULTS Response rate was 20.3% (n = 117), with 49 returns in 2020. Perceived patient barriers included finances, higher among rural versus urban clinics (81.6% vs. 56.1%, p =.009), and time (overall 52.3%). Welcoming environment (95.5%), telephone appointment reminders (74.8%) and streamlined admissions (69.4%) were the top three clinic practices to reduce missed appointments. Telehealth was the most commonly available patient support service in rural (79.6%) and urban (81.8%, p =.90) clinics. Number of providers was positively associated with having a patient navigator/care coordinator (OR = 1.20, CI = 1.02-1.40). For each percent increase in the number of privately insured patients, the odds of providing legal aid decreased by 4% (OR = 0.96, CI = 0.92-1.00). Urban clinics were less likely than rural clinics to provide social work services (OR = 0.16, CI = 0.04-0.67) or assist with applications for government aid (OR = 0.22, CI = 0.06-0.90). CONCLUSIONS Practices to reduce missed appointments included a variety of reminders. Although finances and inability to take time off work were the most frequently reported perceived barriers for patients' access to timely healthcare, most clinics did not directly address them. Rural clinics appeared to have more community partnerships to address underlying social determinants of health, such as transportation and assistance applying for government aid. Taking such a wholistic partnership approach is an area for future study to improve patient access.
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Affiliation(s)
- Kendra L Ratnapradipa
- Department of Epidemiology, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE, 68198-4395, USA.
| | - Runqiu Wang
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Josiane Kabayundo
- Department of Epidemiology, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE, 68198-4395, USA
| | - Walter Marquez Lavenant
- Department of Epidemiology, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE, 68198-4395, USA
| | - Eleanore Nelson
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Muskan Ahuja
- Department of Epidemiology, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE, 68198-4395, USA
| | - Ying Zhang
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Hongmei Wang
- Department of Health Services Research & Administration, University of Nebraska Medical Center, Omaha, NE, USA
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Watanabe-Galloway S, Napit K, McCullough J, Luma LB, Kabayundo J, Carritt NL, Schabloske L, Robinson T, Rohde J, Champion V, LoConte NK, Ratnapradipa KL. Engaging Communities in Cancer Prevention and Control Activity Prioritization through a Statewide Needs Assessment: A Case Study from Nebraska. Cancer Prev Res (Phila) 2024; 17:97-106. [PMID: 38437585 DOI: 10.1158/1940-6207.capr-23-0355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/06/2023] [Accepted: 01/18/2024] [Indexed: 03/06/2024]
Abstract
Community outreach and engagement (COE) activities are important in identifying catchment area needs, communicating these needs, and facilitating activities relevant to the population. The National Cancer Institute-designated cancer centers are required to conduct catchment-wide cancer needs assessments as part of their COE activities. The University of Nebraska Medical Center Buffett Cancer Center undertook a three-year-long process to conduct a needs assessment, identify priorities, and develop workgroups to implement cancer prevention and control activities. Activities were conducted through collaborations with internal and external partners. The needs assessment focused on prevention, early detection, and treatment of cancer and involved secondary data analysis and focus groups with identified underrepresented priority populations (rural, African American, Hispanic, Native American, and LGBTQ+ populations). Results were tailored and disseminated to specific audiences via internal and external reports, infographics, and presentations. Several workgroups were developed through meetings with the internal and external partners to address identified priorities. COE-specific initiatives and metrics have been incorporated into University of Nebraska Medical Center and Buffett Cancer Center strategic plans. True community engagement takes a focused effort and significant resources. A systemic and long-term approach is needed to develop trusted relationships between the COE team and its local communities.
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Affiliation(s)
- Shinobu Watanabe-Galloway
- Department of Epidemiology, University of Nebraska Medical Center, Omaha, Nebraska
- Office of Community Outreach and Engagement, Fred & Pamela Buffett Cancer Center, Omaha, Nebraska
| | - Krishtee Napit
- Department of Epidemiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Jordan McCullough
- Office of Community Outreach and Engagement, Fred & Pamela Buffett Cancer Center, Omaha, Nebraska
| | - Lady Beverly Luma
- Office of Community Outreach and Engagement, Fred & Pamela Buffett Cancer Center, Omaha, Nebraska
| | - Josiane Kabayundo
- Department of Epidemiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Nicole L Carritt
- Office of Community Outreach and Engagement, Fred & Pamela Buffett Cancer Center, Omaha, Nebraska
- Rural Health Initiatives, University of Nebraska Medical Center, Omaha, Nebraska
| | | | | | - Jolene Rohde
- Comprehensive Cancer Control Program, Nebraska Department of Health and Human Services, Lincoln, Nebraska
| | - Victoria Champion
- Community Outreach and Engagement and Population Science, Indiana University Simon Comprehensive Cancer Center, Indianapolis, Indiana
| | - Noelle K LoConte
- Community Outreach and Engagement, University of Wisconsin Carbone Cancer Center, Madison, Wisconsin
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Du Y, Ratnapradipa KL, Su D, Dong J, Rochling FA, Farazi PA. Effects of Interventions for Improving Awareness and Knowledge of Nonalcoholic Fatty Liver Disease Among Chinese Young Adults for Prevention of Liver Cancer-A Randomized Controlled Trial. J Cancer Educ 2024:10.1007/s13187-024-02404-1. [PMID: 38430453 DOI: 10.1007/s13187-024-02404-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 03/03/2024]
Abstract
Chinese young adults (CYA), who are at an increasing risk of developing nonalcoholic fatty liver disease (NAFLD), which in turn increases the risk of liver cancer, are an ideal target population to deliver educational interventions to improve their awareness and knowledge of NAFLD and consequently reduce their risk of developing NAFLD. The purpose of this study was to determine the efficacy of two interventions to improve awareness and knowledge of NAFLD among CYA for the prevention of liver cancer. Between May and July 2021, 1373 undergraduate students aged 18 to 25 years in one university in China completed a web-based, self-administered survey distributed through WeChat app. One week after completion of the baseline survey, all eligible participants were randomly assigned to a pamphlet, a video intervention, or no intervention (control group), with follow-up assessments immediately and 1-month post-intervention. The 7-page pamphlet or 6.5-min video had information on NAFLD. Self-assessments included NAFLD awareness, lean NAFLD awareness, and knowledge scores of NAFLD. About 26% of participants had NAFLD awareness at baseline. Compared with controls, participants in both interventions showed significant improvement of awareness of NAFLD (pamphlet, + 46.0%; video, + 44.3%; control, + 18.7%; OR [95% CI], 3.13 [2.19-4.47] and 2.84 [1.98-4.08]), awareness of lean NAFLD (pamphlet, + 41.2%; video, + 43.0%; control, + 14.5%; OR [95% CI], 2.84 [1.62-4.99] and 2.61 [1.50-4.54]), and knowledge score of NAFLD (pamphlet, + 64.2%; video, + 68.9%; control, - 1.0%; OR [95% CI], 1.62 [1.47-1.80] and 1.67 [1.50-1.86]) at immediately post-intervention. Delivering NAFLD education through a pamphlet or video intervention was effective in improving the awareness and knowledge of NAFLD among CYA.
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Affiliation(s)
- Yi Du
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, 984395 Nebraska Medical Center, 42nd and Emile, Omaha, NE, 68198-4395, USA
| | - Kendra L Ratnapradipa
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, 984395 Nebraska Medical Center, 42nd and Emile, Omaha, NE, 68198-4395, USA
| | - Dejun Su
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, 42nd and Emile, Omaha, NE, 68198, USA
| | - Jianghu Dong
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, 42nd and Emile, Omaha, NE, 68198, USA
| | - Fedja A Rochling
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, 42nd and Emile, Omaha, NE, 68198, USA
| | - Paraskevi A Farazi
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, 984395 Nebraska Medical Center, 42nd and Emile, Omaha, NE, 68198-4395, USA.
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Ratnapradipa KL, Li T, Hsieh MC, Tenner L, Peters ES. Most deprived Louisiana census tracts have higher hepatocellular carcinoma incidence and worse survival. Front Oncol 2024; 14:1331049. [PMID: 38380357 PMCID: PMC10878418 DOI: 10.3389/fonc.2024.1331049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/16/2024] [Indexed: 02/22/2024] Open
Abstract
Background Liver cancer incidence increased in the US from 1975 through 2015 with heterogeneous rates across subpopulations. Upstream or distal area-level factors impact liver cancer risks. Objective The aim of this study was to examine the association between area-level deprivation and hepatocellular carcinoma (HCC) incidence and survival. We also explored the association between area deprivation and treatment modalities. Methods Louisiana Tumor Registry identified 4,151 adult patients diagnosed with malignant HCC from 2011 to 2020 and linked residential address to census tract (CT)-level Area Deprivation Index (ADI) categorized into quartiles (Q1 = least deprived). ANOVA examined the association between ADI quartile and CT age-adjusted incidence rate (AAIR) per 100,000. Chi-square tested the distribution of demographic and clinical characteristics across ADI quartiles. Kaplan-Meier and proportional hazard models evaluated survival by deprivation quartile. Results Among the 1,084 CTs with incident HCC, the average (SD) AAIR was 8.02 (7.05) HCC cases per 100,000 population. ADI was observed to be associated with incidence, and the mean (SD) AAIR increased from 5.80 (4.75) in Q1 to 9.26 (7.88) in Q4. ADI was also associated with receipt of surgery (p < 0.01) and radiation (p < 0.01) but not chemotherapy (p = 0.15). However, among those who received chemotherapy, people living in the least deprived areas began treatment approximately 10 days sooner than those living in other quartiles. Q4 patients experienced the worst survival with a median of 247 (95% CI 211-290) days vs. Q1 patients with a median of 474 (95% CI 407-547) days (p < 0.0001). Q4 had marginally poorer survival (HR 1.20, 1.05-1.37) than Q1 but the association became non-significant (HR 1.12, 0.96-1.30) when adjusted for rurality, liquor store density, sex, race/ethnicity, age, insurance, BMI, stage, hepatitis diagnosis, and comorbidities. Conclusion Increasing neighborhood (CT) deprivation (ADI) was observed to be associated with increased HCC incidence and poorer HCC survival. However, the association with poorer survival becomes attenuated after adjusting for putative confounders.
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Affiliation(s)
- Kendra L. Ratnapradipa
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
| | - Tingting Li
- Louisiana Tumor Registry, Epidemiology Program, School of Public Health at Louisiana State University (LSU) Health Sciences Center-New Orleans, New Orleans, LA, United States
| | - Mei-Chin Hsieh
- Louisiana Tumor Registry, Epidemiology Program, School of Public Health at Louisiana State University (LSU) Health Sciences Center-New Orleans, New Orleans, LA, United States
| | - Laura Tenner
- Department of Internal Medicine, Division of Oncology/Hematology, College of Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - Edward S. Peters
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
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Ratnapradipa KL, Yellala A, Shonka N. Exploratory analysis of the spatial distribution of adult glioma age-adjusted county incidence rates, Nebraska Medicine, 2009-2019. Neurooncol Pract 2024; 11:64-68. [PMID: 38222054 PMCID: PMC10785590 DOI: 10.1093/nop/npad050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
Background Central nervous system (CNS) cancers including gliomas have low incidence but high mortality. The age-adjusted incidence rate for CNS cancers is higher in Nebraska than nationally. This exploratory study was motivated by glioma patient inquiries about possible clustering of cases within the state to see if more in-depth investigation was warranted. Methods Using electronic health records from Nebraska Medicine, we identified Nebraska adult (age ≥19) glioma patients diagnosed between January 1, 2009 and November 1, 2019. Patient residential addresses were geocoded, mapped, and combined with annual US Census data to compute age-adjusted incidence rates (AAIR) at the county level. Counties with fewer than five cases were excluded to protect patient identity. ArcGIS software was used for geocoding and mapping. Results Of the 285 cases included in the analysis, 53.2% were geocoded with exact match and the remainder were processed manually. Cases occurred in 47 of the 93 counties. After data suppression, 11 counties (228 cases) visually clustered in eastern and central Nebraska with AAIR ranging from 0.85 to 5.66 per 100 000. Conclusions Many counties in the state were excluded from analysis of this rare cancer due to the small number of cases leading to unstable rates and the need to suppress data to protect patient privacy. However, this preliminary study suggests that glioma incidence is highest in central and eastern Nebraska. Next steps include analysis of state cancer registry data to ensure more complete case ascertainment.
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Affiliation(s)
- Kendra L Ratnapradipa
- Department of Epidemiology, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, Nebraska, USA
| | - Amulya Yellala
- Department of Internal Medicine, Division of Oncology and Hematology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Nicole Shonka
- Department of Internal Medicine, Division of Oncology and Hematology, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Ratnapradipa KL, Napit K, King KM, Ramos AK, Luma LBL, Dinkel D, Robinson T, Rohde J, Schabloske L, Tchouankam T, Watanabe-Galloway S. African American and Hispanic Cancer Survivors' and Caregivers' Experiences in Nebraska. J Immigr Minor Health 2024:10.1007/s10903-023-01570-6. [PMID: 38180583 DOI: 10.1007/s10903-023-01570-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 01/06/2024]
Abstract
Racial and ethnic minority populations experience poorer cancer outcomes compared to non-Hispanic White populations, but qualitative studies have typically focused on single subpopulations. We explored experiences, perceptions, and attitudes toward cancer care services across the care continuum from screening through treatment among African American and Hispanic residents of Nebraska to identify unique needs for education, community outreach, and quality improvement. We conducted four focus groups (N = 19), April-August 2021 with people who were aged 30 or older and who self-identified as African American or Hispanic and as cancer survivors or caregivers. Sessions followed a structured facilitation guide, were audio recorded and transcribed, and were analyzed with a directed content analysis approach. Historical, cultural, and socioeconomic factors often led to delayed cancer care, such as general disuse of healthcare until symptoms were severe due to mistrust and cost of missing work. Obstacles to care included financial barriers, transportation, lack of support groups, and language-appropriate services (for Hispanic groups). Knowledge of cancer and cancer prevention varied widely; we identified a need for better community education about cancer within the urban Hispanic community. Participants had positive experiences and a sense of hope from the cancer care team. African American and Hispanic participants shared many similar perspectives about cancer care. Our results are being used in collaboration with national and regional cancer support organizations to expand their reach in communities of color, but structural and cultural barriers still need to be addressed.
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Affiliation(s)
- Kendra L Ratnapradipa
- Department of Epidemiology, University of Nebraska Medical Center College of Public Health, 984395 Nebraska Medical Center, Omaha, NE, 68198-4395, USA.
| | - Krishtee Napit
- Department of Epidemiology, University of Nebraska Medical Center College of Public Health, 984395 Nebraska Medical Center, Omaha, NE, 68198-4395, USA
| | - Keyonna M King
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE, USA
| | - Athena K Ramos
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE, USA
| | - Lady Beverly L Luma
- Office of Community Outreach and Engagement, Fred and Pamela Buffett Cancer Center, Omaha, NE, USA
| | - Danae Dinkel
- School of Health and Kinesiology, University of Nebraska at Omaha, Omaha, NE, USA
| | | | - Jolene Rohde
- Nebraska Comprehensive Cancer Control Program, Nebraska Department of Health and Human Services, Lincoln, NE, USA
| | | | - Tatiana Tchouankam
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE, USA
| | - Shinobu Watanabe-Galloway
- Department of Epidemiology, University of Nebraska Medical Center College of Public Health, 984395 Nebraska Medical Center, Omaha, NE, 68198-4395, USA
- Office of Community Outreach and Engagement, Fred and Pamela Buffett Cancer Center, Omaha, NE, USA
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LaCrete F, Ratnapradipa KL, Carlson K, Lyden E, Dowdall JR. Rural-urban otolaryngologic observational workforce analysis: The state of Nebraska. Laryngoscope Investig Otolaryngol 2023; 8:1602-1606. [PMID: 38130258 PMCID: PMC10731502 DOI: 10.1002/lio2.1181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/16/2023] [Indexed: 12/23/2023] Open
Abstract
Objective To analyze the rural-urban access to otolaryngology (OHNS) care within the state of Nebraska. Design Cross-sectional study. Methods Counties in Nebraska were categorized into rural versus urban status based upon the 2013 National Center for Health Statistics urban-rural classification scheme with I indicating most urban and VI indicating most rural. The information on otolaryngologists was gathered utilizing the Health Professions Tracking System. Otolaryngologists were categorized based on the county of their primary and outreach clinic location(s). Travel burden was estimated using census tract centroid distance to the nearest clinic location, aggregated to county using weighted population means to determine the average county distance to the nearest otolaryngologist. Results Nebraska is a state with a population of 1.8 million people unequally distributed across 76,824 square miles, with rural counties covering 2/3 of the land area. Nebraska has 78 primary OHNS clinics and 70 outreach OHNS clinics distributed across 93 counties. More than half (54.8%) of the counties in Nebraska lacked any OHNS clinic. Overall, a statistically significant difference was found when comparing mean primary OHNS per 100,000 population and mean miles to a primary OHNS clinic with Level III counties being 5.17 linear miles from primary OHNS compared to Level V counties being 29.94 linear miles. Conclusion Overall, a clear discrepancy between rural and urban primary OHNS clinics in Nebraska can be seen visually and statistically with rural Nebraskans having to travel at least 5.5 times farther to primary OHNS clinics when compared to urban Nebraskans.
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Affiliation(s)
| | - Kendra L. Ratnapradipa
- Department of EpidemiologyCollege of Public Health, UNMC, 984375 Nebraska Medical CenterOmahaNebraskaUSA
| | - Kristy Carlson
- Department of Otolaryngology—Head and Neck SurgeryCollege of Medicine, UNMC, 984395 Nebraska Medical CenterOmahaNebraskaUSA
| | - Elizabeth Lyden
- Department of BiostatisticsCollege of Public Health, UNMC, 984375 Nebraska Medical CenterOmahaNebraskaUSA
| | - Jayme R. Dowdall
- Department of Otolaryngology—Head and Neck SurgeryCollege of Medicine, UNMC, 984395 Nebraska Medical CenterOmahaNebraskaUSA
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Lawson AB, Kim J, Johnson C, Ratnapradipa KL, Alberg AJ, Akonde M, Hastert T, Bandera EV, Terry P, Mandle H, Cote ML, Bondy M, Marks J, Peres LC, Schildkraut J, Peters ES. The Association between Mediated Deprivation and Ovarian Cancer Survival among African American Women. Cancers (Basel) 2023; 15:4848. [PMID: 37835542 PMCID: PMC10571563 DOI: 10.3390/cancers15194848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/25/2023] [Accepted: 10/02/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Deprivation indices are often used to adjust for socio-economic disparities in health studies. Their role has been partially evaluated for certain population-level cancer outcomes, but examination of their role in ovarian cancer is limited. In this study, we evaluated a range of well-recognized deprivation indices in relation to cancer survival in a cohort of self-identified Black women diagnosed with ovarian cancer. This study aimed to determine if clinical or diagnostic characteristics lie on a mediating pathway between socioeconomic status (SES) and deprivation and ovarian cancer survival in a minority population that experiences worse survival from ovarian cancer. METHODS We used mediation analysis to look at the direct and indirect causal effects of deprivation indices with main mediators of the SEER stage at diagnosis and residual disease. The analysis employed Bayesian structural equation models with variable selection. We applied a joint Bayesian structural model for the mediator, including a Weibull mixed model for the vital outcome with deprivation as exposure. We selected modifiers via a Monte Carlo model selection procedure. RESULTS The results suggest that high SES-related indices, such as Yost, Kolak urbanicity (URB), mobility (MOB) and SES dimensions, and concentrated disadvantage index (CDI), all have a significant impact on improved survival. In contrast, area deprivation index (ADI)/Singh, and area level poverty (POV) did not have a major impact. In some cases, the indirect effects have very wide credible intervals, so the total effect is not well estimated despite the estimation of the direct effect. CONCLUSIONS First, it is clear that commonly used indices such as Yost, or CDI both significantly impact the survival experience of Black women diagnosed with epithelial ovarian cancer. In addition, the Kolak dimension indices (URB, MOB, mixed immigrant: MICA and SES) also demonstrate a significant association, depending on the mediator. Mediation effects differ according to the mediator chosen.
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Affiliation(s)
- Andrew B. Lawson
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
- Usher Institute, School of Medicine, University of Edinburgh, Edinburgh EH16 4UX, UK
| | - Joanne Kim
- Department of Biomedical Informatics, College of Medicine, Ohio State University, Columbus, OH 43210, USA;
| | - Courtney Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA; (C.J.)
| | - Kendra L. Ratnapradipa
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Anthony J. Alberg
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Maxwell Akonde
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Theresa Hastert
- Department of Oncology, Wayne State University School of Medicine, Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI 48201, USA
| | - Elisa V. Bandera
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08625, USA
| | - Paul Terry
- Department of Medicine, University of Tennessee Medical Center-Knoxville, Knoxville, TN 37920, USA
| | - Hannah Mandle
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA; (C.J.)
| | - Michele L. Cote
- Bren Simon Comprehensive Cancer Center, Indiana University Melvin, Inidianapolis, IN 46202, USA;
| | - Melissa Bondy
- Department of Epidemiology and Population Health, College of Medicine, Stanford University, Stanford, CA 94305, USA
| | - Jeffrey Marks
- Department of Surgery, Duke University School of Medicine, Durham, NC 27710, USA;
| | - Lauren C. Peres
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA;
| | - Joellen Schildkraut
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA; (C.J.)
| | - Edward S. Peters
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA
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10
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Lawson AB, Kim J, Johnson C, Hastert T, Bandera EV, Alberg AJ, Terry P, Akonde M, Mandle H, Cote ML, Bondy M, Marks J, Peres L, Ratnapradipa KL, Xin Y, Schildkraut J, Peters ES. Deprivation and segregation in ovarian cancer survival among African American women: a mediation analysis. Ann Epidemiol 2023; 86:57-64. [PMID: 37423270 PMCID: PMC10538403 DOI: 10.1016/j.annepidem.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 07/11/2023]
Abstract
PURPOSE Deprivation and segregation indices are often examined as possible explanations for observed health disparities in population-based studies. In this study, we assessed the role of recognized deprivation and segregation indices specifically as they affect survival in a cohort of self-identified Black women diagnosed with ovarian cancer who enrolled in the African American Cancer Epidemiology Study. METHODS Mediation analysis was used to examine the direct and indirect effects between deprivation or segregation and overall survival via a Bayesian structural equation model with Gibbs variable selection. RESULTS The results suggest that high socioeconomic status-related indices have an association with increased survival, ranging from 25% to 56%. In contrast, index of concentration at the extremes-race does not have a significant impact on overall survival. In many cases, the indirect effects have very wide credible intervals; consequently, the total effect is not well estimated despite the estimation of the direct effect. CONCLUSIONS Our results show that Black women living in higher socioeconomic status neighborhoods are associated with increased survival with ovarian cancer using area-level economic indices such as Yost or index of concentration at the extremes-income. In addition, the Kolak urbanization index has a similar impact and highlights the importance of area-level deprivation and segregation as potentially modifiable social factors in ovarian cancer survival.
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Affiliation(s)
- Andrew B Lawson
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston; Usher Institute, Centre for Population Health Sciences, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK.
| | - Joanne Kim
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus
| | - Courtney Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Theresa Hastert
- Department of Oncology, Wayne State University School of Medicine, Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI
| | - Elisa V Bandera
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick
| | - Anthony J Alberg
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia
| | - Paul Terry
- Department of Medicine, University of Tennessee Medical Center-Knoxville, Knoxville
| | - Maxwell Akonde
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia
| | - Hannah Mandle
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Michele L Cote
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis
| | - Melissa Bondy
- Department of Epidemiology and Population Health, Stanford University, College of Medicine, Stanford, CA
| | - Jeffrey Marks
- Department of Surgery, Duke University School of Medicine, Durham, NC
| | - Lauren Peres
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Kendra L Ratnapradipa
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha
| | - Yao Xin
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston
| | - Joellen Schildkraut
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Edward S Peters
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha
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11
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Napit K, Ratnapradipa KL, King KM, Ramos AK, Luma LBL, Dinkel D, Robinson T, Schabloske L, Tchouankam T, Watanabe-Galloway S. Correction to: Qualitative Analysis of Colorectal Cancer Screening for African American and Hispanic Populations in Nebraska: an Application of the PRECEDE Framework. J Cancer Educ 2023; 38:1777. [PMID: 37552463 DOI: 10.1007/s13187-023-02353-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Affiliation(s)
- Krishtee Napit
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.
| | - Kendra L Ratnapradipa
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Keyonna M King
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Athena K Ramos
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Lady Beverly L Luma
- Office of Community Outreach and Engagement, Fred & Pamela Buffett Cancer Center, Omaha, NE, USA
| | - Danae Dinkel
- School of Health & Kinesiology, University of Nebraska at Omaha, Omaha, NE, USA
| | | | | | - Tatiana Tchouankam
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Shinobu Watanabe-Galloway
- Office of Community Outreach and Engagement, Fred & Pamela Buffett Cancer Center, Omaha, NE, USA
- School of Health & Kinesiology, University of Nebraska at Omaha, Omaha, NE, USA
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12
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Napit K, Ratnapradipa KL, King KM, Ramos AK, Luma LBL, Dinkel D, Robinson T, Schabloske L, Tchouankam T, Watanabe-Galloway S. Qualitative Analysis of Colorectal Cancer Screening for African American and Hispanic Populations in Nebraska: an Application of the PRECEDE Framework. J Cancer Educ 2023; 38:1767-1776. [PMID: 37466902 DOI: 10.1007/s13187-023-02343-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 07/20/2023]
Abstract
Nationally and in Nebraska, African Americans (AA) and Hispanics have lower colorectal cancer (CRC) screening rates compared to non-Hispanic Whites. We aimed to obtain perspectives from AA and Hispanic cancer survivors and caregivers in Nebraska about CRC screening to improve outreach efforts. Data from four virtual focus groups (AA female, AA male, Hispanic rural, and Hispanic urban) conducted between April-August 2021 were analyzed using a directed content approach based on the Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation (PRECEDE) model. Most of the 19 participants were female (84%) and survivors (58%). Across groups, awareness of colonoscopy was high, but awareness of fecal testing needed to be higher, with confusion about different types of fecal tests. Predisposing factors were trust in the health system; awareness of CRC screening; machismo; fear of cancer; embarrassment with screening methods; and negative perceptions of CRC screening. Enabling factors included provider recommendations, healthcare access, and insurance. Reinforcing factors included prioritizing personal health and having a support system. Suggestions to improve screening included increasing healthcare access (free or low-cost care), increasing provider diversity, health education using various methods and media, and enhancing grassroots health promotion efforts. Lack of awareness, accessibility issues, attitudes and perceptions of CRC and CRC screening, trust, and cultural and linguistic concerns are major issues that need to be addressed to reduce CRC screening disparities among AA and Hispanic adults.
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Affiliation(s)
- Krishtee Napit
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.
| | - Kendra L Ratnapradipa
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Keyonna M King
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Athena K Ramos
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Lady Beverly L Luma
- Office of Community Outreach and Engagement, Fred & Pamela Buffett Cancer Center, Omaha, NE, USA
| | - Danae Dinkel
- School of Health & Kinesiology, University of Nebraska at Omaha, Omaha, NE, USA
| | | | | | - Tatiana Tchouankam
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Shinobu Watanabe-Galloway
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
- Office of Community Outreach and Engagement, Fred & Pamela Buffett Cancer Center, Omaha, NE, USA
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13
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Du Y, Rochling FA, Su D, Ratnapradipa KL, Dong J, Farazi PA. Development and Validation of a Questionnaire to Assess Awareness and Knowledge of Nonalcoholic Fatty Liver Disease, a Liver Cancer Etiological Factor, among Chinese Young Adults. Asian Pac J Cancer Prev 2023; 24:1543-1551. [PMID: 37247273 PMCID: PMC10495908 DOI: 10.31557/apjcp.2023.24.5.1543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 05/12/2023] [Indexed: 05/31/2023] Open
Abstract
PURPOSE Despite the increasing prevalence of nonalcoholic fatty liver disease (NAFLD), a liver cancer etiological factor, among Chinese young adults (CYA), there is a lack of valid, reliable, ready-to-use survey instruments for assessing awareness and knowledge of NAFLD in this population. The aims of this study were to develop, validate, and assess the reliability of a web-based, self-administered questionnaire evaluating awareness and knowledge of NAFLD among CYA. METHODS Based on review of relevant literature, a draft questionnaire was initially developed. Face and content validity of the questionnaire was evaluated by an expert panel of seven gastroenterologists. The construct validity was tested through item analysis based on item response theory. Reliability assessment included test-retest for stability and test for internal consistency. Two pilot tests were conducted among 60 randomly selected students at Lanzhou University, China, through WeChat App. RESULTS The content validity and clarity indexes were both greater than 0.85. Face validity was established by concluding that questions had no issue with feasibility, readability, clarity of wording, clarity of layout, and style. Response rates for two pilot tests were 96.7% (58 out of 60) and 98.3% (59 out of 60), respectively. Results testing the construct validity showed estimated amount of information obtained by the test between -3 and +3 range of ability was 97.57%. The test-retest reliability (Pearson's r) was 0.62. The internal consistency (KR20) was 0.92. CONCLUSIONS This newly developed questionnaire is a reliable and valid instrument for assessing awareness and knowledge of NAFLD among this sample from CYA.
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Affiliation(s)
- Yi Du
- University of Nebraska Medical Center, 42nd and Emile, Omaha, NE 68198, USA.
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14
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Ratnapradipa KL, Napit K, Ranta J, Luma LB, Dinkel D, Robinson T, Schabloske L, Watanabe-Galloway S. Qualitative Analysis of Colorectal Cancer Screening in Rural Nebraska. J Cancer Educ 2023; 38:652-663. [PMID: 35437633 PMCID: PMC9015281 DOI: 10.1007/s13187-022-02170-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 05/20/2023]
Abstract
Compared to urban residents, rural populations are less likely to engage in colorectal cancer (CRC) screening. As part of a statewide cancer needs assessment, we aimed to elicit rural perspectives about CRC screening and resources. We conducted three focus groups with rural Nebraska cancer survivors and caregivers (N = 20) in Spring 2021 using a collective case study design. Participant awareness of and knowledge about CRC screening methods varied across focus groups; overall, 95% of participants had heard of colonoscopy. Participants were less familiar with fecal tests and had confusion about them. Colonoscopy was associated with negative perceptions regarding the time, cost, and discomfort of the preparation and procedure, but some providers did not discuss alternative methods unless the patient resisted colonoscopy. Healthcare providers played a key role educating rural communities about CRC screening recommendations (age, risk) and testing options and being persistent in those recommendations. CRC awareness campaigns should include a variety of communication channels (TV, radio, billboards, health fairs, churches, healthcare settings). Promotion of CRC screening should include education about screening age guidelines, alternative test types, and informed decision-making between provider and patient regarding preferred screening methods based on the pros and cons of each test type. Individuals with a family history of colon issues (Crohn's disease, CRC) are considered high risk and need to be aware that screening should be discussed at earlier ages.
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Affiliation(s)
- Kendra L Ratnapradipa
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center (UNMC), NSW, 68198-4395, Omaha, USA.
| | - Krishtee Napit
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center (UNMC), NSW, 68198-4395, Omaha, USA
| | - Jordan Ranta
- Sarpy/Cass Health Department, Papillion, NE, USA
| | - Lady Beverly Luma
- Office of Community Outreach and Engagement, Fred & Pamela Buffett Cancer Center, UNMC, Omaha, NE, USA
| | - Danae Dinkel
- School of Health & Kinesiology, University of Nebraska at Omaha, Omaha, NE, USA
| | | | | | - Shinobu Watanabe-Galloway
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center (UNMC), NSW, 68198-4395, Omaha, USA
- Office of Community Outreach and Engagement, Fred & Pamela Buffett Cancer Center, UNMC, Omaha, NE, USA
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15
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Ratnapradipa KL, Jadhav S, Kabayundo J, Wang H, Smith LC. Factors associated with delaying medical care: cross-sectional study of Nebraska adults. BMC Health Serv Res 2023; 23:118. [PMID: 36739376 PMCID: PMC9899134 DOI: 10.1186/s12913-023-09140-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 02/02/2023] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Delayed medical care may result in adverse health outcomes and increased cost. Our purpose was to identify factors associated with delayed medical care in a primarily rural state. METHODS Using a stratified random sample of 5,300 Nebraska households, we conducted a cross-sectional mailed survey with online response option (27 October 2020 to 8 March 2021) in English and Spanish. Multiple logistic regression models calculated adjusted odds ratios (aOR) and 95% confidence intervals. RESULTS The overall response rate was 20.8% (n = 1,101). Approximately 37.8% of Nebraskans ever delayed healthcare (cost-related 29.7%, transportation-related 3.7%), with 22.7% delaying care in the past year (10.1% cost-related). Cost-related ever delay was associated with younger age [< 45 years aOR 6.17 (3.24-11.76); 45-64 years aOR 2.36 (1.29-4.32)], low- and middle-income [< $50,000 aOR 2.85 (1.32-6.11); $50,000-$74,999 aOR 3.06 (1.50-6.23)], and no health insurance [aOR 3.56 (1.21-10.49)]. Transportation delays were associated with being non-White [aOR 8.07 (1.54-42.20)], no bachelor's degree [≤ high school aOR 3.06 (1.02-9.18); some college aOR 4.16 (1.32-13.12)], and income < $50,000 [aOR 8.44 (2.18-32.63)]. Those who did not have a primary care provider were 80% less likely to have transportation delays [aOR 0.20 (0.05-0.80)]. CONCLUSIONS Delayed care affects more than one-third of Nebraskans, primarily due to financial concerns, and impacting low- and middle-income families. Transportation-related delays are associated with more indicators of low socio-economic status. Policies targeting minorities and those with low- and middle-income, such as Medicaid expansion, would contribute to addressing disparities resulting from delayed care.
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Affiliation(s)
- Kendra L. Ratnapradipa
- grid.266813.80000 0001 0666 4105Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE 68198-4395 USA
| | - Snehal Jadhav
- grid.266813.80000 0001 0666 4105Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE 68198-4395 USA
| | - Josiane Kabayundo
- grid.266813.80000 0001 0666 4105Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE 68198-4395 USA
| | - Hongmei Wang
- grid.266813.80000 0001 0666 4105Department of Health Services Research & Administration, University of Nebraska Medical Center, Omaha, NE USA
| | - Lisa C. Smith
- grid.266815.e0000 0001 0775 5412Grace Abbott School of Social Work, University of Nebraska Omaha, Omaha, NE USA
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16
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Ratnapradipa KL, Chen K, Watanabe-Galloway S, Farazi PA. Cross-sectional Study of Colorectal Cancer Screening Barriers in a Latino-Serving Federally Qualified Health Center. J Cancer Educ 2023; 38:193-200. [PMID: 34599456 DOI: 10.1007/s13187-021-02097-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/25/2021] [Indexed: 06/13/2023]
Abstract
Compared to other races/ethnicities, the Latino population has a lower rate of adherence to colorectal cancer (CRC) screening guidelines. Previous studies have identified a variety of barriers to CRC screening in Latino populations but have not explored factors associated with barriers. The purpose of this study was to identify barriers to CRC screening and associated factors in a Midwest Latino population visiting an urban Federally Qualified Health Center (FQHC). We conducted a cross-sectional investigation of 68 Latinos at a FQHC from June to October 2017. We examined factors associated with scheduling, psychological, and financial barriers using t-test, ANOVA, and multiple linear regression analyses. Our participants reported low educational level, low income, and limited access to insurance or a primary care provider. Scheduling barriers are the highest barrier compared with psychological and financial barriers. Being married or coupled was the only predictor of higher scheduling barriers (P < .05). Being married or coupled was associated with higher psychological barriers in both univariate and multivariate analysis (P < .05). Higher education level was associated with higher psychological barriers in univariate (P < .05) but not multivariate analysis. Participants with lower vs. higher English proficiency had a higher financial barrier score in univariate (P < .05) but not multivariate analysis. Despite interventions targeting CRC screening barriers, including the provision of free at-home testing, perceived barriers persist. Bilingual patient navigators may help address needs for those with limited English proficiency to find and schedule free or reduced-fee colonoscopy services. People who are well educated are also at high risk of psychological barriers and should be targeted and given more education on the importance of CRC screening.
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Affiliation(s)
- Kendra L Ratnapradipa
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Nebraska Medical Center, 984395, Omaha, NE, 68198-4395, USA
| | - Ken Chen
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Nebraska Medical Center, 984395, Omaha, NE, 68198-4395, USA
- College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA
| | - Shinobu Watanabe-Galloway
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Nebraska Medical Center, 984395, Omaha, NE, 68198-4395, USA
| | - Paraskevi A Farazi
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Nebraska Medical Center, 984395, Omaha, NE, 68198-4395, USA.
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17
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Du Y, Su D, Ratnapradipa KL, Dong J, Rochling FA, Farazi PA. Factors Associated with Awareness and Knowledge of Nonalcoholic Fatty Liver Disease, a Liver Cancer Etiological Factor, Among Chinese Young Adults. J Cancer Educ 2022:10.1007/s13187-022-02246-9. [PMID: 36527545 DOI: 10.1007/s13187-022-02246-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/04/2022] [Indexed: 06/17/2023]
Abstract
Despite the increasing prevalence of nonalcoholic fatty liver disease (NAFLD), a liver cancer etiological factor, among Chinese young adults (CYA), there is a lack of study assessing awareness and knowledge of NAFLD among them. This study aimed to assess awareness and knowledge of NAFLD, and identify the factors associated with awareness and knowledge of NAFLD among CYA. We conducted a survey to assess awareness and knowledge of NAFLD among students who enrolled in one university undergraduate program in 2018, 2019, and 2020 through a newly developed web-based, self-administered questionnaire. The outcomes included awareness of NAFLD and knowledge score of NAFLD. We conducted unadjusted and adjusted analyses of associated factors with these outcomes. A total of 1373 students participated in the survey. Of all participants, 26.2% reported that they had heard of NAFLD, 7.7% reported that they had heard of lean NAFLD, and 11.1% received ≥ 20 points in the knowledge section of NAFLD. The mean and median scores were 9.35 (Std = 7.67) and 9 (range 0-27). Factors associated with having awareness and knowledge (≥ 20 points) of NAFLD included medical background, high medical knowledge level, and family history of NAFLD. There was low NAFLD awareness and knowledge among CYA aged 18 to 25 years. Our findings point to the need to develop an educational intervention for CYA to improve their NAFLD awareness and knowledge. Further studies should include information on physical activity and dietary habits to test whether NAFLD awareness and knowledge impact those habits.
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Affiliation(s)
- Yi Du
- University of Nebraska Medical Center, 42nd and Emile, Omaha, NE, 68198-4395, USA
| | - Dejun Su
- University of Nebraska Medical Center, 42nd and Emile, Omaha, NE, 68198-4395, USA
| | | | - Jianghu Dong
- University of Nebraska Medical Center, 42nd and Emile, Omaha, NE, 68198-4395, USA
| | - Fedja A Rochling
- University of Nebraska Medical Center, 42nd and Emile, Omaha, NE, 68198-4395, USA
| | - Paraskevi A Farazi
- University of Nebraska Medical Center, 42nd and Emile, Omaha, NE, 68198-4395, USA.
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Ratnapradipa KL, Ranta J, Napit K, Luma LB, Dinkel D, Robinson T, Schabloske L, Watanabe-Galloway S. QIM22-201: Experiences With Cancer Diagnosis and Treatment in Rural Nebraska: Qualitative Focus Group Analysis. J Natl Compr Canc Netw 2022. [DOI: 10.6004/jnccn.2021.7224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | | | | | - Danae Dinkel
- 1 University of Nebraska Medical Center, Omaha, NE
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19
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Ratnapradipa KL, Ranta J, Napit K, Luma LB, Robinson T, Dinkel D, Schabloske L, Watanabe‐Galloway S. Qualitative analysis of cancer care experiences among rural cancer survivors and caregivers. J Rural Health 2022; 38:876-885. [PMID: 35381622 PMCID: PMC9492624 DOI: 10.1111/jrh.12665] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE Rural (vs urban) patients experience poorer cancer outcomes and are less likely to be engaged in cancer prevention, such as screening. As part of a community needs assessment, we explored rural cancer survivors' and caregivers' experiences, perceptions, and attitudes toward cancer care services. METHODS We conducted 3 focus groups (N = 20) in Spring 2021 in rural Nebraska. FINDINGS Three patterns of cancer diagnosis were regular care/screening without noticeable symptoms, treatment for symptoms not initially identified as cancer related, and symptom self-identification. Most participants, regardless of how diagnosis was made, had positive experiences with timely referral for testing (imaging and biopsy) and specialist care. Physician interpersonal skills set the tone for patient-provider communication, which colored the perception of overall care. Participants with physicians and care teams that were perceived as "considerate," "compassionate," and "caring" had positive experiences. Participants identified specific obstacles to care, including financial barriers, transportation, and lack of support groups, as well as more general cultural barriers. Survivors and caregivers identified organization-based supports that helped them address such barriers. CONCLUSIONS Rural populations have unique perspectives about cancer care. Our results are being used by the state cancer coalition, state cancer control program, and the National Cancer Institute-designated cancer center to prioritize outreach and interventions aimed to reduce rural cancer disparities, such as revitalizing lay cancer navigator programs, conducting webinars for primary care and cancer specialty providers to discuss these findings and identify potential interventions, and collaborating with national and regional cancer support organizations to expand reach in rural communities.
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Affiliation(s)
- Kendra L. Ratnapradipa
- Department of EpidemiologyCollege of Public HealthUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Jordan Ranta
- Sarpy/Cass Health DepartmentPapillionNebraskaUSA
| | - Krishtee Napit
- Department of EpidemiologyCollege of Public HealthUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Lady Beverly Luma
- Office of Community Outreach and EngagementFred & Pamela Buffett Cancer CenterOmahaNebraskaUSA
| | | | - Danae Dinkel
- School of Health & KinesiologyUniversity of Nebraska at OmahaOmahaNebraskaUSA
| | | | - Shinobu Watanabe‐Galloway
- Department of EpidemiologyCollege of Public HealthUniversity of Nebraska Medical CenterOmahaNebraskaUSA,Office of Community Outreach and EngagementFred & Pamela Buffett Cancer CenterOmahaNebraskaUSA
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Abstract
Federal reporting of crash fatalities has limited age-by-sex stratification, but both age and sex are associated with driving reduction and cessation. We described older driver fatal crash involvement and fatalities using Fatality Analysis Reporting System data to calculate rates (per 100,000 licensed drivers, per 100,000 population) with age-by-sex stratifications. Nationally from 2000 through 2017, 110,422 drivers 65+ were involved in crashes resulting in at least one death within 30 days, and 67,843 of these older drivers died. Involvement and fatality rates per 100,000 licensed drivers in 2017 were lowest for females 65-69 (7.7 and 3.6, respectively) and highest for males age 85+ (34.3 and 25.5, respectively). Females had lower driver fatal crash involvement and fatality rates throughout the lifespan, even when rates generally decreased over time. Elaborating fatal crash trends and rates by age and sex helps to differentiate the public health burden of older driver crashes and fatalities.
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Affiliation(s)
| | - Caitlin N. Pope
- Graduate Center for Gerontology, University of Kentucky, Lexington, KY 40536
| | - Ann Nwosu
- Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205
| | - Motao Zhu
- Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205
- Department of Pediatrics, The Ohio State University, Columbus, OH 43205
- Division of Epidemiology, The Ohio State University, Columbus, OH
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21
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Ratnapradipa KL, Ratnapradipa D, Xie Y. Factors Associated with Having Ever Considered a Cancer Research Career. J Cancer Educ 2021; 36:630-638. [PMID: 31900921 DOI: 10.1007/s13187-019-01676-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Increasing cancer workforce diversity is a priority for the National Cancer Institute. Cancer research encompasses a wide range of disciplines including basic, clinical, behavioral, and social sciences, but many research development programs are narrowly focused. Our aim was two-fold: to describe undergraduate students' knowledge of and interest in cancer research careers and to identify factors associated with having ever considered a cancer research career. Undergraduate students (n = 857) completed a paper questionnaire. Most students associated cancer careers with bench science and healthcare or public health, but less so for applied fields. Most respondents (69%) received career counseling in high school but only 4% had cancer-specific career counseling. Nearly half the respondents (49%) indicated they or an immediate family member had been diagnosed with cancer, and 17% had attended a cancer appointment. Only 10% of respondents indicated that they had ever considered a career in cancer research. Associated factors included cancer-specific career counseling (odds ratio [OR] 8.05; 95% confidence interval [CI] 3.60, 18.03), attended a cancer appointment (OR 2.37; 95% CI 1.34, 4.20), being slightly (vs. very) worried about developing cancer (OR 0.32; 95% CI 0.15, 0.68), and Other (vs. White) race (OR 2.83; 95% CI 1.34, 5.97). Personal experience with cancer and knowledge of cancer careers appear to be driving factors in career choice for cancer research. Increasing student exposure to cancer careers, possibly in junior high or high school, may be one mechanism for recruiting more underrepresented undergraduate students into cancer-related fields of study.
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Affiliation(s)
- Kendra L Ratnapradipa
- Department of Epidemiology, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE, 68198-4395, USA.
| | | | - Yue Xie
- Department of Population Health, Sam Houston State University, Huntsville, TX, USA
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Shen S, Ratnapradipa KL, Pervall GC, Sweeney M, Zhu M. Driver License Renewal Laws and Older Adults' Daily Driving, United States, 2003-2017. J Gerontol B Psychol Sci Soc Sci 2021; 75:2268-2277. [PMID: 32479637 DOI: 10.1093/geronb/gbaa070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Around the world, aging populations pose significant concerns regarding their community mobility and transportation safety. Most previous studies in the United States have focused on the associations between driver license renewal laws and crash outcomes among older adults (65 years and older). Few studies have evaluated the impact of driver license renewal laws on older adults' community mobility. This study aimed to identify the associations between driver license renewal laws and older males' and females' daily driving likelihood and duration. METHOD The 2003-2017 American Time Use Survey data were merged with driver license renewal legislation using ages 55-64 to control for effects of non-licensure factors (e.g., gasoline price). Weighted Poisson and linear regression models were used to estimate the associations of various driver licensure provisions with older males' and females' daily driving likelihood and duration. RESULTS A shorter in-person renewal period and the presence of mandatory reporting laws for physicians were associated with a lower daily driving likelihood and shorter driving duration among females aged 75 years or older. The presence of mandatory reporting laws was also associated with reduced daily driving likelihood and duration for males aged 65-74 years. DISCUSSION Policymakers should be aware that males and females may respond differently to older driver licensure laws, which may require distinct interventions to preserve their mobility. Future studies should consider the gender disparities when examining the association between driver licensure policies and older adults' transportation safety and mobility.
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Affiliation(s)
- Sijun Shen
- Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus
| | - Kendra L Ratnapradipa
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha
| | - Gina C Pervall
- Maryland Department of Transportation Motor Vehicle Administration, Glen Burnie
| | - Meredith Sweeney
- Assistive Technology Department at Ohio State University Wexner Medical Center, Columbus
| | - Motao Zhu
- Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus.,Division of Epidemiology, College of Public Health, The Ohio State University, Columbus
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Ratnapradipa KL, Wang J, Berg-Weger M, Schootman AM. Effects of Older Adult Driving Resumption on All-Cause Mortality. J Gerontol B Psychol Sci Soc Sci 2020; 75:2263-2267. [PMID: 31076775 DOI: 10.1093/geronb/gbz058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Driving cessation is associated with adverse social and health outcomes including increased mortality risk. Some former drivers resume driving. Do resumed drivers have a different mortality risk compared to former drivers or continued drivers? METHOD We analyzed National Health and Aging Trends Study (2011-2015) data of community-dwelling self-responding ever drivers (n = 6,189) with weighted stratified life tables and discrete time logistic regression models to characterize mortality risk by driving status (continued, resumed, former), adjusting for relevant sociodemographic and health variables. RESULTS Overall, 14% (n = 844) of participants died and 52% (n = 3,209) completed Round 5. Former drivers had the highest mortality (25%), followed by resumed (9%) and continued (6%) drivers. Former drivers had 2.4 times the adjusted odds of mortality compared with resumed drivers (adjusted odds ratio [aOR] = 2.41; 95% confidence interval [CI] = 1.51, 3.83), with no difference between continued and resumed drivers (aOR = 1.22; 95% CI = 0.74, 1.99). DISCUSSION Those who resumed driving had better survival than those who did not. Practice implications include driver rehabilitation and retraining to safely promote and prolong driving.
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Affiliation(s)
- Kendra L Ratnapradipa
- Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University, Columbus
| | - Jing Wang
- College of Nursing & Health Innovation, University of Texas at Arlington, Missouri
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24
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Li A, Shen S, Nwosu A, Ratnapradipa KL, Cooper J, Zhu M. Investigating traffic fatality trends and restraint use among rear-seat passengers in the United States, 2000-2016. J Safety Res 2020; 73:9-16. [PMID: 32563412 PMCID: PMC7362329 DOI: 10.1016/j.jsr.2020.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 09/09/2019] [Accepted: 02/17/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Motor-vehicle crash is one of the leading causes of unintentional injury death in the United States. Previous studies focused on fatalities among drivers and front-seat passengers, with a limited number of studies examining rear-seat passenger fatalities. The objectives of this study were to assess trends in rear-seat passenger motor-vehicle fatalities in the United States from 2000 to 2016 and to identify demographic factors associated with being unrestrained among fatally injured rear-seat passengers. METHODS Rear-seat passenger fatality data were obtained from the Fatality Analysis Reporting System (FARS) database. The fatality rate ratios for overall rear-seat passengers and for different age and sex groups were determined by comparing fatality rates in 2000 and 2016 using random effects models. Risk ratios of being unrestrained for age and sex groups were obtained using general estimating equations. RESULTS Compared to 2000, the overall rear-seat passenger fatality rate in 2016 decreased by 44% (95% confidence interval [CI]: 39-49%). In particular, the fatality rate among rear-seat passengers decreased more in males than females, and passengers aged 14-19 years experienced a larger decline than all other age groups. Fatally injured male rear-seat passengers had a higher risk of being unrestrained (adjusted risk ratio: 1.06, 95% CI: 1.04-1.07) than their female counterparts, and both youngest (≤13 years) and oldest (65-85 years) passengers were less likely to be unrestrained than those aged 20-64 years. CONCLUSIONS Overall, fatality rates among rear-seat passengers have declined, with differential degrees of improvement by age and sex. Practical Applications: Continued restraint use enforcement campaigns targeted at teenagers and males would further preserve them from fatal injuries and improve traffic safety for the overall population.
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Affiliation(s)
- Amy Li
- College of Medicine and Life Sciences, University of Toledo, 700 Children's Drive, Columbus, OH 43205-2664, United States.
| | - Sijun Shen
- Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States; Department of Pediatrics, College of Medicine, The Ohio State University, 700 Children's Drive, Columbus, OH 43205, United States.
| | - Ann Nwosu
- Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States.
| | - Kendra L Ratnapradipa
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE 68198-4395, United States.
| | - Jennifer Cooper
- Center for Surgical Outcomes Research and Center for Innovation in Pediatric Practice, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States; Department of Pediatrics, College of Medicine, The Ohio State University, 700 Children's Drive, Columbus, OH 43205, United States.
| | - Motao Zhu
- Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States; Department of Pediatrics, College of Medicine, The Ohio State University, 700 Children's Drive, Columbus, OH 43205, United States; Division of Epidemiology, College of Public Health, The Ohio State University, 700 Children's Drive, Columbus, OH 43205, United States.
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Abstract
Objective Motor vehicle crashes are a leading cause of injury death in the United States, and Memorial Day weekend is one of six holiday periods with an increased number of motor vehicle fatalities in the United States. However, few motor vehicle fatality comparisons were made between Memorial Day weekend and non-holiday periods. Our aims were to determine which day(s) during the holiday had highest motor vehicle fatality risk compared to non-holiday travel and to identify potential risk factors. Results Of 43,457 traffic fatalities studied, 15,292 (35%) occurred during the holiday, with Saturday being deadliest but Monday having highest odds of traffic fatality. Both sexes, all years, age < 65, drivers and passengers, rural and urban, and all regions in the United States were at increased risk during the holiday versus non-holiday periods.
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Affiliation(s)
- Yuni Tang
- Department of Epidemiology, School of Public Health, West Virginia University, Morgantown, WV, USA
| | | | - Henry Xiang
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA.,Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA.,Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Motao Zhu
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA. .,Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA. .,Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
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26
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Chaudhuri U, Ratnapradipa KL, Shen S, Rice TM, Smith GA, Zhu M. Trends and patterns in fatal US motorcycle crashes, 2000-2016. Traffic Inj Prev 2019; 20:641-647. [PMID: 31283363 PMCID: PMC6706857 DOI: 10.1080/15389588.2019.1628224] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 05/22/2019] [Accepted: 06/03/2019] [Indexed: 05/07/2023]
Abstract
Objective: To investigate trends of motorcyclist fatalities and identify at-risk populations by motorcyclist demographics and crash characteristics. Methods: We used the Fatality Analysis Reporting System (FARS) database (2000-2016) to track fatality rate trends, which were quantified by using Poisson mixed-effects regression models comparing 2000-2001 and 2007-2008, as well as 2009-2010 and 2015-2016. Results: The overall fatality rate per 100,000 population increased from 2000 to 2016, defined by two trend lines-before and after the economic recession in 2008-2009. The overall fatality rate ratio between 2000-2001 and 2007-2008 was 1.60 [95% Confidence Interval (CI): 1.51-1.70], and between 2009-2010 and 2015-2016 was 1.09 (95% CI: 1.02-1.18). Fatality rates increased among all age groups, particularly for motorcyclists aged 60 and older. Those aged 18-29 had the highest fatality rates overall. Age-and-sex standardized state fatality rates were consistently highest in Wyoming, South Dakota, and South Carolina and lowest in Massachusetts, New York and New Jersey. Conclusion: Motorcycle fatality rates increased overall and across all age groups between 2000 and 2016. Fatalities for the oldest riders showed the steadiest increasing trends. Results highlight the continued public health burden of motorcyclist fatalities and, by extension, the importance of improving motorcycle safety.
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Affiliation(s)
- Urmimala Chaudhuri
- a Department of Population and Public Health Sciences, Wright State University Boonshoft School of Medicine , Fairborn , Ohio
| | - Kendra L Ratnapradipa
- b Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital , Columbus , Ohio
- c Department of Pediatrics, College of Medicine, The Ohio State University , Columbus , Ohio
| | - Sijun Shen
- b Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital , Columbus , Ohio
- c Department of Pediatrics, College of Medicine, The Ohio State University , Columbus , Ohio
| | - Thomas M Rice
- d Safe Transportation Research & Education Center, University of California Berkeley , Berkeley , California
| | - Gary A Smith
- b Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital , Columbus , Ohio
- c Department of Pediatrics, College of Medicine, The Ohio State University , Columbus , Ohio
- e Division of Epidemiology, College of Public Health, The Ohio State University , Columbus , Ohio
| | - Motao Zhu
- b Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital , Columbus , Ohio
- c Department of Pediatrics, College of Medicine, The Ohio State University , Columbus , Ohio
- e Division of Epidemiology, College of Public Health, The Ohio State University , Columbus , Ohio
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Abstract
Background and Objectives Predictors and consequences of driving cessation in older adults have been studied extensively. This study sought to establish the extent to which former drivers resume driving and identify associated factors. Research Design and Methods Descriptive analysis of the 2011–2015 National Health and Aging Trends Study data (Round 1: n = 6,680; Round 5: n = 3,409) characterized the extent of driving resumption through 2015 by baseline driving status (driver, former driver, never driver). Weighted multivariate logistic regression and multilevel longitudinal models examined predictors of driving resumption. Results Among drivers who stopped driving during the study, 17%–28% resumed driving. Age, vehicle ownership, stroke, hospitalization, memory, and perceived transportation barriers were associated with resumption in regression analysis. In multilevel analysis stratified by baseline driving status, poor word recall (OR = 0.62; 95% CI = 0.40, 0.95) and use of public transportation (OR = 9.74; 95% CI = 1.54, 61.77) were significantly associated with driving resumption for baseline drivers, while use of taxi (OR < 0.001; 95% CI = <0.001, 0.02) was negatively associated with resumption for baseline former drivers. Discussion and Implications This study highlights several factors associated with driving resumption. Uncertainty about the underlying causes for resumption remains, so results should be interpreted with caution. However, predictive factors may help to identify individuals in need of additional mobility transition counseling. Ongoing transportation assessment may be warranted among former drivers.
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Affiliation(s)
- Kendra L Ratnapradipa
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Jing Wang
- Department of Graduate Nursing, College of Nursing & Health Innovation, University of Texas at Arlington
| | - Marla Berg-Weger
- School of Social Work, College for Public Health and Social Justice, Saint Louis University, Missouri
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Ratnapradipa KL, Norrenberns R, Turner JA, Kunerth A. Freshman Flu Vaccination Behavior and Intention During a Nonpandemic Season. Health Promot Pract 2017; 18:662-671. [DOI: 10.1177/1524839917712731] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective. To examine predictors of flu vaccination and vaccination intention among college freshmen during a nonpandemic influenza season using the health belief model (HBM). Participants. A total of 184 college freshmen at a single institution participated in a mixed-mode (paper or online) survey in October-November 2015. Method. Flu vaccination and intention to vaccinate were predicted using binomial logistic regression on HBM constructs (perceived susceptibility, severity, benefits, barriers, cues to action, and availability), prior flu vaccination history, family and peer reference behaviors, and demographics. Results. Overall, 31.5% of participants received the seasonal flu vaccine by mid-November, and 25% intended to receive it. In full models, history of past flu vaccination (adjusted odds ratio [aOR] = 7.90; 95% confidence interval [CI] = 2.55-24.49) was significant for vaccination while availability (aOR = 2.00; 95% CI = 1.32-3.01) and family intention (aOR = 250.59; 95% CI = 3.77 to >999) were positively associated with intent to vaccinate. Significant confounding by past behavior and family intentions existed for both outcomes. Conclusions. Past flu vaccination behavior and family member intentions to vaccinate were better predictors of annual flu vaccination behavior and intention than HBM constructs among college freshmen. College campuses may enhance flu vaccine coverage by highlighting benefits and availability to students and families.
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