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BACKGROUND: Perceived weight discrimination is associated consistently with worse health outcomes. Coping strategies may be one mechanism of this association. The present research examined the association between perceived weight discrimination and strategies used to cope with general stress (not weight-specific) and whether these strategies accounted for part of the association with markers of health. METHOD: Participants (N = 1882) completed a cross-sectional survey with a comprehensive measure of coping strategies and reported on their perceived experience of weight discrimination and markers of physical, mental, and social health. RESULTS: Perceived weight discrimination was associated with greater use of disengaged coping strategies (ß = .19, p < .01) and was unrelated to active and support coping strategies. Disengaged coping mediated the association between weight discrimination and worse physical, mental, and social health (proportion of mediation ranged from 14 to 47%). This pathway was independent of body mass index (BMI). Individuals in the obesity weight category (BMI ≥ 30 kg/m2) were less likely to use active (ß = - .11, p < .01) and support (ß = - .09, p < .01) coping strategies, which did not consistently mediate the association with health. CONCLUSION: Perceived experiences of weight discrimination are associated with disengaged coping strategies to manage stressful experiences, and these strategies are one mechanism that may contribute to the worse health associated with unfair treatment due to weight.
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BACKGROUND: Perceived weight discrimination is associated with increased risk for chronic diseases and reduced life expectancy. Nevertheless, little is known about perceived weight discrimination in racial, ethnic, and sexual minority groups or in individuals at the intersections of those groups. The goal of this study was to identify sociodemographic predictors of perceived weight discrimination. SUBJECTS/METHODS: A diverse sample of adults (37% Black/African American, 36% Latino, 29% sexual minority) with a body mass index (BMI) ≥ 18.5 kg/m2 were recruited from a national US panel to complete an online survey (N = 2454). Perceived weight discrimination was assessed with the Stigmatizing Situations Survey-Brief (SSI-B). Using hierarchical linear regression analysis, SSI-B scores were predicted from the four sociodemographic characteristics of interest (gender, race, ethnicity, and sexual orientation) while controlling for BMI, age, education, and income (Step 1). At Step 2, all two-way interactions between the four sociodemographic characteristics were added to the model. RESULTS: At Step 1, higher SSI-B scores were observed for Latino (vs. non-Latino) adults, sexual minority (vs. heterosexual) adults, younger (vs. older) adults, adults with higher (vs. lower) levels of education, and adults with higher (vs. lower) BMI. At Step 2, race interacted with gender, ethnicity, and sexual orientation to predict SSI-B scores such that relatively higher scores were observed for non-Black women, Black men, adults who identified as Black and Latino, and non-Black sexual minority adults. CONCLUSIONS: Perceived weight discrimination varied across sociodemographic groups, with some subgroups reporting relatively high frequency. Black race appeared to be protective for some subgroups (e.g., Black women), but risk-enhancing for others (e.g., Black men, individuals who identified as Black and Latino). Additional research is needed to identify specific factors that cause certain sociodemographic groups -and indeed, certain individuals-to perceive higher levels of weight discrimination than others.
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Índice de Masa Corporal , Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Estados Unidos/epidemiología , Hispánicos o Latinos/estadística & datos numéricos , Hispánicos o Latinos/psicología , Factores Sociodemográficos , Prejuicio de Peso/psicología , Prejuicio de Peso/estadística & datos numéricos , Factores Socioeconómicos , Encuestas y Cuestionarios , Anciano , Adulto Joven , Obesidad/psicología , Obesidad/epidemiología , Obesidad/etnología , Negro o Afroamericano/estadística & datos numéricos , Negro o Afroamericano/psicologíaRESUMEN
African Americans have been disproportionately affected by COVID-19 and COVID-19 vaccines were initially met with hesitancy from the African American community. This study identified predictors of COVID-19 vaccination intentions among students attending a Historically Black College and University (HBCU) when COVID-19 vaccines first became available. Unvaccinated students (N = 224) completed a survey. Path analysis modeled relationships among exogenous variables (trust, exposure to pro- and anti-vaccine information), proposed mediators (Health Belief Model variables), and COVID-19 vaccination intentions. Students reported low trust in government officials, medical professionals, and the vaccine development process. Direct predictors of vaccination intentions included trust, perceived benefits, and perceived barriers. Students with lower trust reported lower benefits, increased concerns about side effects, and were more likely to view COVID-19 vaccination as low priority, and these factors in turn predicted intentions. Findings highlight the urgent need for theory-driven, culturally sensitive, age-relevant messaging to reduce vaccine hesitancy among Black young adults.
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Negro o Afroamericano , Vacunas contra la COVID-19 , COVID-19 , Modelo de Creencias sobre la Salud , Intención , Confianza , Vacilación a la Vacunación , Humanos , Femenino , Masculino , Negro o Afroamericano/psicología , Adulto Joven , COVID-19/prevención & control , Adulto , Vacilación a la Vacunación/psicología , Estudiantes/psicología , Conocimientos, Actitudes y Práctica en Salud/etnología , Vacunación/psicología , Adolescente , Universidades , SARS-CoV-2 , Encuestas y CuestionariosRESUMEN
High-risk sexual behavior is the primary risk factor for the acquisition and persistence of human papillomavirus (HPV) infection and the development of HPV-associated diseases including cancer. Incidence of HPV infection is high among individuals in their late teens and early 20s. Thus, college students represent a historically high-risk group for HPV infection yet are also a group with the ability to independently access HPV vaccination for HPV prevention. To inform future interventions, we examined factors associated with HPV-associated risky sexual behaviors among sexually active college students. Data (N = 741) were from an anonymous online survey distributed to students at a public Midwestern university in 2021. The outcomes were HPV-associated sexual risk behaviors-number of oral or vaginal sexual partners [high (≥ 5) or low (< 5)] and age of oral or vaginal sexual debut [early (< 18 years) or late (≥ 18 years)]. Multivariable logistic regression models estimated the association between HPV-associated risky sexual behaviors and several predictors including age, gender, relationship status, academic level, country of birth, and rural-urban status. Among sexually active students, approximately 47% and 41% had a high number of lifetime vaginal and oral partners, respectively. Among the same group, 60% and 64% had early vaginal and oral sexual debut. Students who were single and dating (aOR = 1.93; 95% CI = 1.21, 3.08) or single and not dating (2.11; 1.28, 3.48) were more likely to have a high number of vaginal lifetime partners compared with married students. Single (vs. married) students were also about twice as likely to have a high number of oral lifetime partners. Relative to graduate students, freshmen/sophomores were more likely to have an early vaginal (2.44; 1.45, 4.11) and oral (2.14; 1.26, 3.63) sexual debut. Interventions tailored to college freshmen/sophomores and unmarried students should encourage students to receive the HPV vaccine for prevention of future HPV-associated diseases.
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Infecciones por Papillomavirus , Femenino , Adolescente , Humanos , Infecciones por Papillomavirus/prevención & control , Conducta Sexual , Parejas Sexuales , Factores de Riesgo , Estudiantes , Asunción de RiesgosRESUMEN
OBJECTIVES: We sought to identify trends in the main reasons United States parents of unvaccinated children gave for not intending to vaccinate their adolescent children against HPV from 2010 to 2020. As interventions designed to increase vaccine uptake have been implemented across the United States, we predicted that reasons for hesitancy have changed over this period. METHODS: We analyzed data from the 2010 to 2020 National Immunization Survey-Teen, which included 119 695 adolescents aged 13 to 17 years. Joinpoint regression estimated yearly changes in the top five cited reasons for not intending to vaccinate using annual percentage changes. RESULTS: The five most frequently cited reasons for not intending to vaccinate included "not necessary," "safety concerns," "lack of recommendation," "lack of knowledge," and "not sexually active." Overall, parental HPV vaccine hesitancy decreased by 5.5% annually between 2010 and 2012 and then remained stable for the 9-year period of 2012 through 2020. The proportion of parents citing "safety or side effects" as a reason for vaccine hesitancy increased significantly by 15.6% annually from 2010 to 2018. The proportion of parents citing "not recommended," "lack of knowledge," or "child not sexually active" as reasons for vaccine hesitancy decreased significantly by 6.8%, 9.9%, and 5.9% respectively per year between 2013 and 2020. No significant changes were observed for parents citing "not necessary." CONCLUSIONS: Parents who cited vaccine safety as a reason for not intending to vaccinate their adolescent children against HPV increased over time. Findings support efforts to address parental safety concerns surrounding HPV vaccination.
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Infecciones por Papillomavirus , Vacunas contra Papillomavirus , Adolescente , Niño , Humanos , Estados Unidos , Virus del Papiloma Humano , Vacilación a la Vacunación , Infecciones por Papillomavirus/prevención & control , Conocimientos, Actitudes y Práctica en Salud , Vacunación , PadresRESUMEN
BACKGROUND: People with obesity face significant discrimination due to their weight. Exposure to such discrimination is associated with poor health outcomes. Little is known about pathways that explain that association, and even less is known about those pathways in racial, ethnic, and sexual minorities. Health risk behaviors may serve as one such pathway. PURPOSE: We examined associations between weight discrimination and health risk behaviors and assessed whether associations are moderated by gender, race, ethnicity, or sexual orientation. METHODS: Quota sampling was used to oversample Black (36%), Latino (36%), and sexual minority (29%) adults (n = 2,632) who completed an online survey. Using regression analysis, health risk behaviors (maladaptive eating behaviors, physical inactivity, sitting, smoking, alcohol use, and sleep disturbance) were predicted from previous experience with weight discrimination while controlling for demographic characteristics, BMI, and depressive symptoms. Additional analyses tested for interactions between weight discrimination and key demographic variables (i.e., gender, race, ethnicity, and sexual minority status). RESULTS: Weight discrimination was associated with greater emotional eating, binge eating, unhealthy weight control behaviors, cigarette smoking, problematic alcohol use, and sleep disturbance. Gender moderated the association between weight discrimination and binge eating, alcohol use, and physical activity, with stronger effects observed in men than women. Exploratory analyses provided limited evidence for differential effects of weight discrimination across specific combinations of intersecting identities. CONCLUSIONS: Weight discrimination was associated with engagement in unhealthy behaviors and relationships were largely similar across diverse demographic groups. Health risk behaviors may represent a key pathway through which weight discrimination harms health.
People with high body weight remain one of the most stigmatized groups in the USA and face significant discrimination due to their weight. Experiencing weight discrimination is associated with poor health, yet little is known about the underlying pathways that explain this association and even less is known about those pathways in socially marginalized groups. We investigated unhealthy behavior as a possible a pathway by assessing associations between weight discrimination and several health risk behaviors and identifying whether those associations vary by gender, race, ethnicity, or sexual orientation. A diverse sample of 2,632 U.S. adults completed an online survey. Previous experience with weight discrimination was found to be associated with greater emotional eating, binge eating, unhealthy weight control behaviors, cigarette smoking, problematic alcohol use, and poor sleep. The association between weight discrimination and binge eating, alcohol use, and physical activity was stronger in men than in women, yet exploratory analyses provided limited evidence for differential effects of weight discrimination across specific combinations of intersecting identities. Weight discrimination was associated with engagement in unhealthy behaviors and associations were largely similar across participants from diverse demographic groups. Health risk behaviors may represent a key pathway through which weight discrimination harms health.
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Conductas de Riesgo para la Salud , Prejuicio de Peso , Adulto , Femenino , Humanos , Masculino , Etnicidad , Hispánicos o Latinos , Minorías Sexuales y de Género , Conducta Sexual , Negro o Afroamericano , Prejuicio de Peso/etnología , Prejuicio de Peso/psicología , Prejuicio de Peso/estadística & datos numéricosRESUMEN
This research differentiated childhood unpredictability (i.e., perceptions of uncertainty or instability due to turbulent environmental changes) from other related constructs to identify its role in adult health. Study 1 (N = 441) showed that, beyond other childhood adversity variables (poverty and adverse childhood experiences or ACEs) and demographic characteristics, perceptions of unpredictability were associated with greater functional disability and worse health-related quality of life (assessed via the CDC's HRQOL Healthy Days measure and the RAND SF-36). Study 2 (N = 564) replicated those findings in a more racially diverse sample and showed that associations with childhood unpredictability held while also controlling for the Big 5 personality traits. Findings suggest that effects of unpredictability were especially pronounced among Hispanic (in Study 1), and Black/African American and low-income participants (in Study 2). Experiencing childhood environments that are perceived to be uncertain, unstable, or uncontrollable may put children on a path toward poor health outcomes in adulthood. Findings advance theories of child adversity and health and identify childhood unpredictability as a potentially valuable target for intervention.
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Experiencias Adversas de la Infancia , Calidad de Vida , Niño , Adulto , Humanos , Estado de Salud , Pobreza , IncertidumbreRESUMEN
We describe the level of awareness of the link between HPV and HPV-associated cancers and identify demographic and lifestyle factors associated with awareness. This was a cross-sectional study of college students (n = 862) at a public Midwestern university conducted between February and May 2021. The outcomes were student's awareness-accessed by asking students if they knew whether HPV was causally link with anal, cervical, vaginal, oropharyngeal, vulvar, and penile cancers. Logistic regression models estimated the association between sociodemographic and sexual behavior and awareness of the link between HPV and HPV-associated cancers. Approximately 70% were aware that HPV causes cervical, 53% were aware HPV causes vaginal, 40% were aware HPV causes vulvar cancers, 39% were aware HPV causes oropharyngeal, 38% were aware HPV causes penile, and 34% were aware HPV causes anal cancers. In multivariable analyses, men were less likely to be aware that HPV causes vaginal (aOR = 0.42, 95% CI 0.30-0.59) or vulvar cancers (aOR = 0.54, 95% CI 0.38-0.77) compared to women. Compared with sexually naïve students, those who had have oral and vaginal sex were more likely to be aware that HPV causes anal (aOR = 1.98, 95% CI 1.17-3.34), penile (aOR = 1.82, 95% CI 1.11-2.97), vaginal (aOR = 1.81, 95% CI 1.14-2.88), or vulvar (aOR = 2.05, 95% CI 1.24-3.40) cancers. Awareness of the link between HPV and HPV-associated cancers was low, except cervical. This underscores the need for more tailored interventions to increase knowledge about HPV and its association with cancer. Increasing students' levels of awareness may impact HPV vaccine uptake.
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Infecciones por Papillomavirus , Vacunas contra Papillomavirus , Neoplasias del Cuello Uterino , Neoplasias de la Vulva , Masculino , Humanos , Femenino , Virus del Papiloma Humano , Neoplasias del Cuello Uterino/epidemiología , Neoplasias del Cuello Uterino/prevención & control , Infecciones por Papillomavirus/prevención & control , Estudios Transversales , Estudiantes , Conocimientos, Actitudes y Práctica en Salud , PapillomaviridaeRESUMEN
Human Papillomavirus (HPV) is associated with six cancers and widespread immunization with HPV vaccine could reduce the number of these cancers. Although HPV vaccination rates are available for the state of Illinois and the city of Chicago, data are limited for specific areas. We assessed rates of HPV vaccine initiation and completion among adolescents in central Illinois and identified factors associated with initiation and completion. This was a retrospective study of adolescents (aged 11-17) who receive care at the Southern Illinois University Medicine Department of Pediatrics. The outcome variables were HPV vaccination initiation (receipt of ≥ 1 dose) and completion (receipt of ≥ 2 or 3 doses, depending on age of initiation). Multivariable logistic regressions were used to identify factors associated with HPV vaccine uptake. A total of 9,351 adolescents were included in the study. Overall, HPV vaccine initiation was 46.2% and completion was 24.7%. In adjusted analyses, adolescents residing in rural areas were 38% and 24% less likely to initiate (aOR = 0.62; 95 CI: 0.54-0.72) and complete (aOR = 0.76; 95 CI: 0.65-0.88) the HPV vaccine compared with those residing in urban areas. Similarly, adolescents were less likely to initiate and complete the HPV vaccine if they were not update to date on the hepatitis A, meningococcal, or Tdap vaccinations. HPV vaccination rates in central Illinois were low, and far below the national average and the Illinois state average. Future directions should include interventions to increase HPV vaccine uptake, particularly in rural areas.
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Infecciones por Papillomavirus , Vacunas contra Papillomavirus , Humanos , Adolescente , Niño , Cobertura de Vacunación , Infecciones por Papillomavirus/prevención & control , Estudios Retrospectivos , Vacunación , IllinoisRESUMEN
The purpose of this study was to evaluate the impact of an ongoing multidisciplinary childhood obesity intervention, within a federally qualified health center, on mental health and physical activity outcomes with Latino children from an agricultural community. The program was evaluated using attendance and parent-reports of child mental health and physical activity levels. Paired t-tests and chi squared tests were used to examine pre-post change in outcomes. There were 100 total participants. The mean age was 9.40 years, and the mean BMI percentile was 97.39. Significant post-intervention improvements were observed in mental health externalizing and internalizing problems (p <.0001) and in weekly physical activity frequency (p =.0131) and duration (p = .0280). Childhood obesity interventions should target mental health problems as well as obesity as the two are closely related. Community health centers may be ideal settings for interventions as they can facilitate access to needed services for high-risk populations.
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Centros Comunitarios de Salud , Ejercicio Físico , Hispánicos o Latinos , Salud Mental , Obesidad Infantil , Humanos , Hispánicos o Latinos/psicología , Hispánicos o Latinos/estadística & datos numéricos , Obesidad Infantil/etnología , Niño , Masculino , Femenino , Ejercicio Físico/psicología , Salud Mental/etnología , Centros Comunitarios de Salud/organización & administración , Evaluación de Programas y Proyectos de Salud , AdolescenteRESUMEN
Objective: The present study aims to examine the threshold of coronavirus disease 2019 (COVID-19) vaccine hesitancy over time and public discourse around COVID-19 vaccination hesitancy. Methods: We collected 3,952 questions and 66,820 answers regarding COVID-19 vaccination posted on the social question-and-answer website Quora between June 2020 and June 2021 and employed Word2Vec and Sentiment Analysis to analyze the data. To examine changes in the perceptions and hesitancy about the COVID-19 vaccine, we segmented the data into 25 bi-weekly sections. Results: As positive sentiment about vaccination increased, the number of new vaccinations in the United States also increased until it reached a ceiling point. The vaccine hesitancy phase was identified by the decrease in positive sentiment from its highest peak. Words that occurred only when the positive answer rate peaked (e.g., safe, plan, best, able, help) helped explain factors associated with positive perceptions toward vaccines, and the words that occurred only when the negative answer rate peaked (e.g., early, variant, scientists, mutations, effectiveness) suggested factors associated with vaccine hesitancy. We also identified a period of vaccine resistance, where people who decided not to be vaccinated were unlikely to be vaccinated without further enforcement or incentive. Conclusions: Findings suggest that vaccine hesitancy occurred because concerns about vaccine safety were high due to a perceived lack of scientific evidence and public trust in healthcare authorities has been seriously undermined. Considering that vaccine-related conspiracy theories and fake news prevailed in the absence of reliable information sources, restoring public trust in healthcare leaders will be critical for future vaccination efforts.
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HPV vaccination is most effective if received before initiation of sexual activity. Previous studies suggested that young adult women who were not sexually active were not interested in receiving the vaccine because they did not think it was necessary. Whether this misperception is still prevalent today-and also shared by men-is unknown. This study examined whether sexual activity was associated with HPV vaccine uptake (initiation and completion) among university students. A cross-sectional study was conducted between February and May 2021 among students (n = 951) at a public Midwestern University. Sexual activity was categorized as "never" or "ever" had oral and/or vaginal sex. Outcome variables were HPV vaccine initiation, defined as receipt of ≥1 dose, and completion, defined as receipt of ≥3 doses. Multivariable logistic regression models estimated the association between sexual activity and HPV vaccine uptake, adjusting for sociodemographic factors. Approximately 18% of students reported never engaging in sexual activity. Overall, 45.5% initiated the HPV vaccine, and 16.5% completed the vaccine series. After adjusting for covariates, compared to students that reported never engaging in sexual activity, those that had ever engaged in sexual activity were more likely to have initiated the vaccine series (aOR = 2.06, 95% CI: 1.34-3.17); however, no difference was observed for completion. HPV vaccination was low; sexually naïve students were less likely to initiate the HPV vaccine. Since sexually naïve students may benefit from receiving the HPV vaccination, targeted interventions should be implemented towards this population to help increase vaccination rates and prevent HPV-associated diseases.
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BACKGROUND AND OBJECTIVE: Because they deviate from societal expectations regarding thinness, women with high body weight or large body size frequently experience social devaluation and discrimination and such experiences can negatively affect health. Yet relatively little is known about experiences of weight discrimination among people impacted by overlapping forms of oppression such as racism, sexism, and heterosexism or how high body weight may intersect with other marginalized identities to contribute to health disparities. Guided by an intersectional lens, the purpose of the current study was to assess Black, Latina, and sexual minority women's experiences with weight discrimination and to identify factors associated with vulnerability or resilience to the harmful health consequences of weight discrimination in these women. METHODS: Semi-structured interviews were conducted with thirty-two cisgender women from the United States who identified as Black, Latina, and/or a sexual minority (e.g., lesbian, bisexual) to assess their experiences with and responses to weight discrimination. All participants had a body mass index ≥30 kg/m2 and had previously experienced weight discrimination. Data collection took place from June to August of 2020. RESULTS: Five factors associated with vulnerability or resilience to experiencing or being negatively affected by weight discrimination were identified: 1) sociocultural norms about weight and perceived acceptance of high body weight, 2) perceived links among weight, perceived femininity, and attractiveness, 3) childhood experiences, 4) internalized weight stigma, and 5) coping strategies. The intersectional nature of women's experiences with weight discrimination was apparent in each theme. CONCLUSIONS: This study identified key factors that may amplify or mitigate the negative health consequences of weight discrimination in socially marginalized women with high body weight. Findings highlight novel research questions to be explored in future research. Such research will be critical for guiding future interventions aimed at reducing the harmful health consequences of weight discrimination.
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Homosexualidad Femenina , Minorías Sexuales y de Género , Femenino , Humanos , Población Negra , Hispánicos o Latinos , DelgadezRESUMEN
BACKGROUND: Women with behavioral health (BH) conditions (e.g., mental illness and substance abuse) receive fewer cervical cancer (CC) screenings, are diagnosed at more advanced cancer stages, and are less likely to receive specialized treatments. The aim of this study was to identify barriers that healthcare providers face in providing CC screening to women with BH conditions. METHODS: Guided by the Consolidated Framework for Implementation Research, we conducted four focus groups in North Florida with 26 primary care and BH clinicians and staff to examine perceived barriers to CC screening among their patients with BH conditions to guide the future development of a tailored cervical cancer screening and follow-up intervention. Thematic analysis was used to analyze verbatim transcripts from audiotaped focus groups. RESULTS: Three main themes of barriers emerged from the data: 1) BH conditions related barriers included a history of trauma, stigma and discrimination, and uncontrolled comorbid conditions, 2) System level barriers related to lack of integration between BH and primary care, and 3) Similar barriers to the general population including lack of health insurance, insufficient processes to send out reminders, and challenges with communicating with patients. CONCLUSIONS: Tailored CC screening interventions that address the unique needs of women with BH conditions are needed. Strategies that address improving trust between patients and healthcare providers, identifying avenues to improve receipt of screening during time-limited clinical visits, connecting BH and primary care providers, and addressing the social determinants of health have potential to improve CC screening rates for women with BH conditions.
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Detección Precoz del Cáncer/psicología , Personal de Salud/psicología , Trastornos Mentales/psicología , Atención Primaria de Salud , Neoplasias del Cuello Uterino/diagnóstico , Adulto , Femenino , Florida , Grupos Focales , Humanos , Persona de Mediana Edad , Investigación Cualitativa , Estigma Social , Neoplasias del Cuello Uterino/psicologíaRESUMEN
BACKGROUND: After a certain age, cancer screening may expose older adults to unnecessary harms with limited benefits and represent inefficient use of health care resources. OBJECTIVE: To estimate the frequency of cervical, breast, and colorectal cancer screening among adults older than US Preventive Services Task Force (USPSTF) age thresholds at which screening is no longer considered routine and to identify physician and patient factors associated with low-value cancer screening. DESIGN: Observational study using pooled cross-sectional data (2011-2016) from the National Ambulatory Medical Care Survey, a nationally representative probability sample of US office-based physician visits. PARTICIPANTS: Analyses for cervical and breast cancer screening were limited to visits by women over age 65 (N=37,818) and ages 75 and over (N=19,451), respectively. Analyses for colorectal cancer screening were limited to visits by patients over age 75 (N=31,543). MAIN MEASURES: Cancer screening procedures were coded as low value using USPSTF age thresholds. KEY RESULTS: Between 2011 and 2016, an estimated 509, 507, and 273 thousand potentially low-value Pap smears, mammograms, and colonoscopies/sigmoidoscopies, respectively, were ordered annually. Low-valuecervical cancer screening was less likely to occur for visits with older (vs. younger) patients. Compared to visits by non-HispanicWhite women, low-valuecervical and breast cancer screening was less likely to occur for visits by women whose race/ethnicitywas something other than non-HispanicWhite, non-HispanicBlack, or Hispanic. Obstetrician/gynecologistswere more likely to order low-valuePap smears and mammograms compared to family/generalpractice physicians. CONCLUSIONS: Thousands of cervical, breast, and colorectal cancer screenings at ages beyond routine guideline thresholds occur each year in the USA. Further research is needed to understand whether this pattern represents clinical inertia and resistance to de-adoption of previous screening practices, or whether physicians and/or patients perceive a higher value in these tests than that endorsed by experts writing evidence-based guidelines.
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Neoplasias de la Mama , Neoplasias Colorrectales , Médicos , Anciano , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/epidemiología , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/epidemiología , Estudios Transversales , Detección Precoz del Cáncer , Femenino , Humanos , Tamizaje Masivo/métodos , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVE: The aim of this study was to describe people's day-to-day experiences with weight-based discrimination and to distill themes that shed new light on this phenomenon. DESIGN: A qualitative study was conducted in 2019 using a purposive sampling strategy. A racially and ethnically diverse sample of 32 U.S. adult men and women with a body mass index ≥30 kg/m2 completed a semi-structured interview. RESULTS: Primary types of interpersonal weight-based discrimination included offensive comments, negative assumptions, social rejection, and unwanted attention or bullying. Participants also encountered environmental sources of weight bias such as inadequate seating in public venues. Three higher order themes that cut across people's experiences with weight-based discrimination were identified: 1) the often-ambiguous nature of weight-based discrimination; 2) intersections between body weight and other social identities; and 3) the role of social comparison processes. CONCLUSION: Findings provide a detailed portrait of people's everyday experiences with weight-based discrimination. These experiences often reflected widely held negative stereotypes about people with higher body weight and conveyed the socially devalued status of higher-weight individuals in society. Findings have important implications for future research and interventions aimed at reducing the harmful effects of weight-based discrimination on health and emotional wellbeing.
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Prejuicio de Peso , Adulto , Índice de Masa Corporal , Emociones , Femenino , Humanos , Masculino , Sobrepeso , Investigación CualitativaRESUMEN
INTRODUCTION: Short message service (SMS) is a widely accepted telecommunications approach used to support health informatics, including behavioral interventions, data collection, and patient-provider communication. However, SMS delivery platforms are not standardized and platforms are typically commercial "off-the-shelf" or developed "in-house." As a consequence of platform variability, implementing SMS-based interventions may be challenging for both providers and patients. Off-the-shelf SMS delivery platforms may require minimal development or technical resources from providers, but users are often limited in their functionality. Conversely, platforms that are developed in-house are often specified for individual projects, requiring specialized development and technical expertise. Patients are on the receiving end of programming and technical specification challenges; message delays or lagged data affect quality of SMS communications. To date, little work has been done to develop a generalizable SMS platform that can be scaled across health initiatives. OBJECTIVE: We propose the Configurable Assessment Messaging Platform for Interventions (CAMPI) to mitigate challenges associated with SMS intervention implementation (e.g., programming, data collection, message delivery). METHOD: CAMPI aims to optimize health data captured from a multitude of sources and enhance patient-provider communication through a technology that is simple and familiar to patients. Using representative examples from three behavioral intervention case studies implemented among diverse populations (pregnant women, young sexual minority men, and parents with young children), we describe CAMPI capabilities and feasibility. CONCLUSION: As a generalizable SMS platform, CAMPI can be scaled to meet the priorities of various health initiatives, while reducing unnecessary resource utilization and burden on providers and patients. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Informática Médica/tendencias , Envío de Mensajes de Texto/normas , Salud de la Familia/tendencias , Estudios de Factibilidad , Humanos , Envío de Mensajes de Texto/instrumentaciónRESUMEN
This study examined the interactive effects of acculturation (host culture acquisition) and enculturation (heritage culture retention) on Latina/o caregivers' beliefs about their child completing the human papillomavirus vaccine series. Participants were 161 caregiver-child dyads from Florida. Using multiple regression, caregiver knowledge and health beliefs (perceived threat, benefits, barriers, subjective norms, and self-efficacy) about series completion were predicted from caregivers' scores on acculturation, enculturation, and their interaction, controlling for sociodemographics. Acculturation and enculturation interacted to predict knowledge, benefits, barriers, and self-efficacy. Caregivers with high acculturation scores generally supported series completion, regardless of their enculturation score. However, when acculturation was low, caregivers who retained more (vs. less) of their heritage culture were more knowledgeable and held more favorable beliefs about series completion. Findings highlight the importance of independently assessing acculturation and enculturation in Latina/o immigrant populations. Overlooking enculturation may lead to incomplete conclusions about acculturation and health.