Racial and ethnic disparities in human papillomavirus (HPV) vaccine uptake among United States adults, aged 27-45 years

In 2018, the Food and Drug Administration expanded the age of eligibility for the human papillomavirus (HPV) vaccine to 27 to 45 years. However, it is unclear if there are racial/ethnic disparities in HPV vaccine uptake for this age-group following this expanded recommendation. We aimed to identify any disparities in HPV vaccine in 27 to 45 year-olds based on sociodemographic factors. We analyzed nationally representative, cross-sectional data from the 2019 National Health Interview Survey (n = 9440). Logistic regression models estimated the odds of vaccine uptake (receipt of ≥1 vaccine dose) based on sociodemographic factors. Participants were mostly Non-Hispanic Whites (60.7%) and females (50.9%). In adjusted models, females had over three times greater odds of vaccine uptake compared to males (aOR = 3.58; 95% CI 3.03, 4.23). Also, compared to Non-Hispanic Whites, Non-Hispanic Blacks were 36% more likely (aOR = 1.36; 95% CI 1.09, 1.70), and Hispanics were 27% less likely (aOR = 0.73; 95% CI 0.58, 0.92) to receive the vaccine. Additionally, individuals without a usual place of care had lower odds of vaccine uptake (aOR = 0.72; 95% CI 0.57, 0.93), as were those with lower educational levels (aORhigh school = 0.62; 95% CI 0.50, 0.78; aORsome college = 0.83; 95% CI 0.70, 0.98). There are disparities in HPV vaccine uptake among 27 to 45 year-olds, and adult Hispanics have lower odds of receiving the vaccine. Given the vaccine's importance in cancer prevention, it is critical that these disparities are addressed and mitigated.

Understanding the effect of new U.S. cervical cancer screening guidelines and modalities on patients' comprehension and reporting of their cervical cancer screening behavior

With recent shifts in guideline-recommended cervical cancer screening in the U.S., it is important to accurately measure screening behavior. Previous studies have indicated the U.S. National Health Interview Survey (NHIS), a resource for measuring self-reported screening adherence, has lower validity among non-White racial/ethnic groups and non-English speakers. Further, measuring diverse population groups' comprehension of items and attitudes toward HPV self-sampling merits investigation as it is a modality likely to be recommended in the U.S. soon. This study cognitively tested NHIS items assessing recency of and reasons for receiving cervical cancer screening and attitudes toward HPV self-sampling. We conducted cognitive interviews between April 2021 - April 2022 in English and Spanish with individuals screened in the past two years by either a medical center in metropolitan Seattle, Washington or a safety-net healthcare system in Dallas, Texas. Interviews probed understanding of reasons for screening, experiences with abnormal results, and interest in HPV self-sampling. We completed 32 interviews in Seattle and 42 interviews in Dallas. A majority of participants were unaware that two different tests for cervical cancer screening exist (Pap and HPV). Many did not know which type(s) of test they received. Dallas participants had more limited and inaccurate knowledge of HPV compared to Seattle participants, and fewer responded favorably toward HPV self-sampling (32% vs. 55%). To improve comprehension and accurate reporting of cervical cancer screening, we suggest specific refinements to currently used survey questions. Attitudes toward self-sampling should be explored further as differences may exist by region and/or sociodemographic factors.

Healthcare Access and Utilization for Young Adults With Disability: U.S., 2014-2018

PURPOSE

Young adults with disability experience barriers to healthcare access and are at risk for not receiving needed services as they transition from pediatric to adult health systems. This study examined patterns of healthcare utilization for young adults with disability and potential barriers to receipt of care.

METHODS

Data from the 2014 to 2018 National Health Interview Survey were analyzed to examine differences in service utilization, unmet need, care satisfaction, and financial worry between young adults (18-30 years) with and without disability (unweighted n = 15,710). Odds ratios were adjusted for individual, family, and interview characteristics.

RESULTS

Compared to those without disability, young adults with disability were more likely to have had an emergency room visit in the past year (39.2% vs. 19.5%). They were also more likely to have a usual source of care when sick (82.2% vs. 75%). Among young adults who affirmed they had a usual place of care, those with disability were more likely to use the emergency room as their usual place of care (5.3% vs. 1.8%). A greater percentage of young adults with disability delayed medical care due to cost (19.1% vs. 8.9%) and reported an unmet medical need (21% vs. 10.2%).

CONCLUSIONS

Findings highlight gaps in healthcare access for young adults with disability. Differences in healthcare utilization patterns for young adults with disability and factors that may negatively influence health outcomes for this population were found. Further research focused on the continuity of healthcare services in this age group through the healthcare transition period may provide additional insight into these discrepancies.

Healthy People 2020: Social Determinants of Cigarette Smoking and Electronic Cigarette Smoking among Youth in the United States 2010-2018

The purpose of this study was to determine social determinants of cigarette smoking and ever using electronic cigarettes (e-cigarettes) among young adults aged 18 to 25 years in the United States between 2010 and 2018. Using secondary data from National Health Interview Surveys (NHIS) across the 2010, 2014, and 2018 survey years, this study analyzed the prevalence rates of cigarette smoking and ever using e-cigarettes between 2010 and 2018, demographic and socioeconomic disparities in smoking, and the relationship between previous e-cigarette use and current smoking. First, the past decade witnessed a notable decline in conventional cigarette smoking and a sharp increase in e-cigarette use among youth. These trends were consistent regardless of socioeconomic status. Second, demographic and socioeconomic disparities persisted in cigarette smoking. Non-Hispanic white male youth were more likely to become smokers as they grew older. Young people with lower educational attainment, living below the U.S. federal poverty level, and having a poor physical health status had a higher smoking prevalence. Third, previous e-cigarette use was more likely to relate to subsequent cigarette use among young people. To achieve the Healthy People 2020 objectives, tobacco control programs and interventions need to be more specific in higher prevalence groups and service providers should not assume that there is a one-size-fits-all model for youth.

Disparities in complementary alternative medicine use and asthma exacerbation in the United States

Background: Complementary and alternative medicines (CAM) are associated with poor asthma medication adherence, a major risk factor for asthma exacerbation. However, previous studies showed inconsistent relationships between CAM use and asthma control due to small sample sizes, demographic differences across populations studied, and poor differentiation of CAM types.Methods: We examined associations between CAM use and asthma exacerbation using a cross-sectional analysis of the 2012 National Health Interview Survey. We included adults ≥18 years with current asthma (n = 2,736) to analyze racial/ethnic differences in CAM use as well as the association between CAM use and both asthma exacerbation and emergency department (ED) visit for asthma exacerbation across racial/ethnic groups. We ran descriptive statistics and multivariable logistic regressions.Result: Blacks (OR = 0.63 [0.49-0.81]) and Hispanics (OR = 0.66 [0.48-0.92]) had decreased odds of using CAM compared to Whites. Overall, there was no association between CAM use and asthma exacerbation (OR = 0.99 [0.79-1.25]) but the subgroup of 'other complementary approaches' was associated with increased odds of asthma exacerbation among all survey respondents (1.90 [1.21-2.97]), Whites (OR = 1.90 [1.21-2.97]), and Hispanics (OR = 1.43 [0.98-2.09). CAM use was associated with decreased odds of an ED visit for asthma exacerbation (OR = 0.65 [0.45-0.93]). These associations were different among racial/ethnic groups with decreased odds of ED visit among Whites (OR = 0.50 [0.32-0.78]) but no association among Blacks and Hispanics.Conclusion: We found that both CAM use and the association between CAM use and asthma exacerbation varied by racial/ethnic group. The different relationship may arise from how CAM is used to complement or to substitute for conventional asthma management.

Association between sleep and serious psychological distress in patients with diabetes

Diabetes is the 7^th leading cause of death in the U.S. and impacts patients' physical health and also increases the risk for psychological distress. Sleep disturbance is a common complaint in patients with diabetes and likely impacts psychological well-being. This study examined the relationship between sleep characteristics and serious psychological distress (SPD) in people with diabetes by conducting a secondary analysis of cross-sectional data from the 2015 National Health Interview Survey (N= 3474). Approximately 7% of the participants reported SPD and 27% reported sleep durations that were shorter or longer than the recommended 6-8 hours daily. Hierarchical logistic regression analysis showed that people who reported daily sleep of 1-5 hours or 9 or more hours were more likely to report SPD than individuals who slept 6-8 hours a day. Respondents who reported a higher frequency of taking medication for sleep and having trouble staying asleep were also substantially more likely to have SPD. However, an increase in the number of days feeling rested when waking up was a protective factor that decreased the risk of SPD. The findings suggest that both sleep disturbances and SPD, because of their high prevalence, should be included in the routine evaluation for diabetes care.

US racial/ethnic disparities in childhood asthma emergent health care use: National Health Interview Survey, 2013-2015

Objective: Racial/ethnic disparities in Emergency Department (ED) visits due to childhood asthma are well documented. We assessed disparities among multiple racial/ethnic groups and examined the effects of asthma management in emergent health care use among children in the United States.Methods: Data come from the sample child component of the 2013-2015 National Health Interview Survey (NHIS) (ages 2-17). Among children with current asthma, (N = 3336) we assessed racial/ethnic disparities in ED visits due to asthma in the past 12 months. We used multivariate logistic regression to calculate model adjusted odds ratios (ORs) including adjustment of asthma management questions available in NHIS 2013: use of an asthma action plan, preventative medication use, and an asthma management course.Results: Using 2013-2015 NHIS data, Puerto Rican children had the highest prevalence of current asthma (21.2%). Among children with asthma, significantly higher odds of ED visits were seen among all minority subgroups (except non-Hispanic other) compared to non-Hispanic white children with Hispanic other having the highest adjusted odds ratio (OR = 2.4), followed by Puerto Rican (OR = 2.0), Mexican American (OR = 1.8) and non-Hispanic black children (OR = 1.7). In sub analyses using 2013 data, adjustment of management measures resulted in a modest to no effect in the odds of having an ED visit due to asthma.Conclusions: The high prevalence of asthma and the disparity in asthma related ED visits among minority children exemplify the need for further research in understanding the mechanisms underlying the continuing existence of these health imbalances.

Prevalence and patterns of use of mantra, mindfulness and spiritual meditation among adults in the United States

BACKGROUND

Despite a growing body of scientific literature exploring the nature of meditation there is limited information on the characteristics of individuals who use it. This is particularly true of comparative studies examining prevalence and predictors of use of various forms of meditation.

METHODS

A secondary analysis was conducted using data from the 2012 National Health Interview Survey (n = 34,525). Three popular forms of meditation were compared-mantra, mindfulness, and spiritual-to determine lifetime and 12-month use related to key sociodemographic, health behavior, health status, and healthcare access variables.

RESULTS

The 12-month prevalence for meditation practice was 3.1% for spiritual meditation, 1.9% for mindfulness meditation, and 1.6% for mantra meditation. This represents approximately 7.0, 4.3, and 3.6 million adults respectively. A comparison across the three meditation practices found many similarities in user characteristics, suggesting interest in meditation may be more related to the type of person meditating than to the type of practice selected. Across meditation styles use was more prevalent among respondents who were female, non-Hispanic White, college educated, physically active; who used other complementary health practices; and who reported depression. Higher utilization of conventional healthcare services was one of the strongest predictors of use of all three styles. In addition to similarities, important distinctions were observed. For example, spiritual meditation practice was more prevalent among former drinkers. This may reflect use of spiritual meditation practices in support of alcohol treatment and sobriety. Reasons for use of meditation were examined using the sample of respondents who practiced mindfulness meditation. Wellness and prevention (74%) was a more common reason than use to treat a specific health condition (30%). Common reasons for use included stress management (92%) and emotional well-being (91%), and to support other health behaviors. Meditation was viewed positively because it was self-care oriented (81%) and focused on the whole person (79%).

CONCLUSION

Meditation appears to provide an accessible, self-care resource that has potential value for mental health, behavioral self-regulation, and integrative medical care. Considering consumer preference for distinct types of meditation practices, understanding the underlying mechanisms, benefits, and applications of practice variations is important.

Physical activity levels and counseling by health care providers in cancer survivors

Physical activity guidelines for cancer survivors issued by the American Cancer Society and the American College of Sports Medicine emphasize the essential role of a health care provider (HCP) in counseling cancer survivors to achieve healthier lifestyles. However, research has not established whether HCP's recommendations to engage in physical activity are associated with increased physical activity levels of cancer survivors. The study examines this potential association using the 2005 and 2010 National Health Interview Survey data. The final analytic sample consisted of 3320 cancer survivors and 38,955 adults without cancer who reported seeing or talking to a HCP and if or not they had received a physical activity recommendation in the prior year. Consistent with the aforementioned guidelines, physical activity levels were categorized as inactive, insufficiently active, and sufficiently active (i.e., meeting guidelines). Average adjusted predictions and marginal effects were estimated from generalized ordered logit models. Multivariable regressions controlled for socio-demographic and health-related characteristics and survey year. On average, receipt of a HCP's physical activity recommendation was associated with a lower adjusted prevalence of inactivity by 8.3 percentage points and a higher adjusted prevalence of insufficient and sufficient activity by 4.6 and 3.7 percentage points, respectively, regardless of cancer diagnosis (P's<0.05). A HCP's recommendation is associated with higher levels of leisure-time aerobic physical activity among cancer survivors and adults without cancer. The communication between cancer survivors and their HCPs may act as a 'window' of opportunity to increase physical activity levels among the U.S. cancer survivors.

The prevalence of herb and dietary supplement use among children and adolescents in the United States: Results from the 2007 National Health Interview Survey

OBJECTIVE

The purpose of this study is to examine the national prevalence of herb and dietary supplement usage among children and adolescents age 4-17 in the United States, and to identify population factors associated with usage.

METHODS

Weighted population estimates are derived from the 2007 National Health Interview Child Complementary and Alternative Medicine Supplement (sample n=9417). Wald chi-square tests are used to compare factors associated with herb and dietary supplement use.

RESULTS

An estimated 2.9 million children and adolescents used herbs or dietary supplements in 2007. Pediatric herb and supplement use was more common among adolescents and non-Hispanic whites, and positively associated with parental education and household income. Children with activity limitations due to chronic health conditions, long-term prescription use, or relatively heavy use of physician services were also more likely to use herbal supplements. Echinacea and fish oil were most commonly used herbs and supplements.

CONCLUSIONS

Children in the US appear to use herbs or dietary supplements at a much lower rate than adults. This analysis shows a pattern of moderate and appropriate herb and supplement use in the pediatric population.