Screening Beyond the Evidence: Patterns of Age and Comorbidity for Breast, Cervical, and Colorectal Cancer Screening.

BACKGROUND: Little evidence exists to guide continuation of screening beyond the recommended ages of national guidelines for breast, cervical, and colorectal cancers, although increasing age and comorbidity burden is likely to reduce the screening benefit of lower mortality. OBJECTIVE: Characterize screening after recommended stopping ages, by age and comorbidities in a large, diverse sample. DESIGN: Serial cross-sectional. PARTICIPANTS: All individuals in the PROSPR-I consortium cohorts from 75 to 89 years of age for breast cancer screening, 66-89 years of age for cervical cancer screening, and 76-89 years of age for colorectal cancer screening from 2011 to 2013. The lower age thresholds were based on the guidelines for each respective cancer type. MAIN MEASURES: Proportion of annual screening by cancer type in relation to age and Charlson comorbidity score and median years of screening past guideline age. We estimated the likelihood of screening past the guideline-based age as a function of age and comorbidity using logistic regression. KEY RESULTS: The study cohorts included individuals screening for breast (n = 33,475); cervical (n = 459,318); and colorectal (n = 556,356) cancers. In the year following aging out, approximately 30% of the population was screened for breast cancer, 2% of the population was screened for cervical, and almost 5% for colorectal cancer. The median number of years screened past the guideline-based recommendation was 5, 3, and 4 for breast, cervical, and colorectal cancer, respectively. Of those screening > 10 years past the guideline-based age,15%, 46%, and 25% had ≥ 3 comorbidities respectively. Colorectal cancer screening had the smallest decline in the likelihood of screening beyond the age-based recommendation. CONCLUSIONS: The odds of screening past guideline-based age decreased with comorbidity burden for breast and cervical cancer screening but not for colorectal. These findings suggest the need to evaluate shared decision tools to help patients understand whether screening is appropriate and to generate more evidence in older populations.

Epidemiological analysis of fatal and non-fatal firearm injuries occurring in gun establishments in the United States, 2015-2022.

BACKGROUND: Firearm-related injury represents a significant public health problem in the USA. Firearm purchasing has risen nationwide and there has been increased efforts to deploy injury prevention initiatives within gun establishments. However, firearm-related risks and harms that may occur inside these high-exposure settings are not well characterized. METHODS: This secondary analysis leveraged Gun Violence Archive data to quantify firearm injury prevalence rates within different types of gun establishments from 1 January 2015 to 31 December 2022. Data were restricted to incidents that occurred in gun ranges, gun shops, and public and private ranges. The following incident characteristics were available in the individual-level data: date, location, injury count, fatality count, victim demographics (age, sex), shooting intent (suicide/self-inflicted, assault/homicide, unintentional, undetermined) and establishment type. RESULTS: Over 7 years, 445 non-fatal and 183 fatal shooting events occurred across 576 unique establishments. Non-fatal, unintentional injuries predominated in stand-alone firing ranges whereas fatal, self-inflicted injuries concentrated in retail shops with accompanying firing ranges. Firearm-related assaults were prevalent among stand-alone retail shops. CONCLUSION: Overall, this secondary analysis underscores that the prevalence of firearm injury in gun establishments across the USA is low, and these settings should continue to be studied as important contexts for intervention. Interweaving public health interventions into gun establishments presents an opportunity to potentially reduce associated harms to consumers interacting within these environments.

Adolescent Polysubstance Use and Co-Occurring Weapon Carrying, Bullying Victimization, and Depressive Symptomology: Patterns and Differences in the United States.

Adolescent substance use commonly co-occurs with poor mental health, bullying victimization and risky behaviors that may lead to violence. The purpose was to describe the United States (US) national prevalence of polysubstance use and co-occurring characteristics and associated demographic characteristics among youth. Middle and high school students in the 2019 CDC YRBS survey reported their demographics and current ( ≥ 1 days in the last 30 days) substances used (alcohol, cigarette, e-cigarette, cannabis); polysubstance combinations were generated. Cross-sectional weighted logistic regression estimated odds of polysubstance use and frequent use ( ≥ 6 days in the last 30 days) by weapon carrying, depressive symptoms, bullying victimization, and demographics. Mean age of the sample was 16 years, 51% were boys, 51% were non-Hispanic White. While accounting for 21% of the sample, 22-40% of Multiracial youth reported polysubstance use and frequent use. Odds of frequent polysubstance use (all combinations) were highest for weapon carrying youth.

Assessing the Prevalence Rates of Internalizing Symptomatology Among Multiracial Adolescents in the United States: A Systematic Review.

This systematic review aimed to investigate the prevalence of internalizing symptomatology among Multiracial adolescents in the United States and to report on the methods utilized to measure Multiracial race and internalizing symptoms. A comprehensive search was conducted in Ovid MEDLINE, Embase, APA PsycInfo, and Web of Science Core Collection. The search was confined to peer-reviewed studies reporting the prevalence of any internalizing symptom among Multiracial adolescents between 10 and 24 years in the United States. Study selection, data abstraction, and quality assessments were managed by four team members. Between 2000 and 2023, nine studies provided prevalence estimates and used various methods to measure Multiracial race and internalizing symptoms. Prevalence estimates displayed considerable variability depending on symptom examined and measurement method utilized. For all internalizing symptomatology, estimates ranged between 7.5 and 55.2%; for depressive symptomatology, estimates ranged between 12.8 and 51.0%. No information on the prevalence of anxiety symptoms alone were provided. This review represents a pioneering attempt to report the prevalence of internalizing symptomatology among Multiracial adolescents in the United States, revealing significant gaps in current knowledge and methodological inconsistencies in the field. There exists a need for more comprehensive epidemiological research with this growing population.

Toward Tailored and Targeted Communication for the Promotion of Firearm Safety: A Qualitative Study With Firearm Retailers.

Firearm injury is a major yet understudied public health issue in the U.S. This qualitative study explored firearm retailers' perspectives to inform messaging and communication approaches to promote firearm safety among the gun owning population. Semi-structured interviews were conducted with 17 retailers at a single gun shop in Texas. Thematic analysis identified key themes related to (1) audience segmentation, (2) appropriate use of language, and (3) trusted messengers and modalities for the communication of firearm safety information. This formative work provides practical insights to optimize public health messaging in this arena and ultimately reduce firearm injuries. Overall, this study provides valuable insights to guide the development and implementation of evidence-based, social marketing efforts aiming to promote firearm safety across various gun-owning audiences.

Web-Based Conversations Regarding Fathers Before and During the COVID-19 Pandemic: Qualitative Content Analysis.

BACKGROUND: Studies of new and expecting parents largely focus on the mother, leaving a gap in knowledge about fathers. OBJECTIVE: This study aimed to understand web-based conversations regarding new and expecting fathers on social media and to explore whether the COVID-19 pandemic has changed the web-based conversation. METHODS: A social media analysis was conducted. Brandwatch (Cision) captured social posts related to new and expecting fathers between February 1, 2019, and February 12, 2021. Overall, 2 periods were studied: 1 year before and 1 year during the pandemic. SAS Text Miner analyzed the data and produced 47% (9/19) of the topics in the first period and 53% (10/19) of the topics in the second period. The 19 topics were organized into 6 broad themes. RESULTS: Overall, 26% (5/19) of the topics obtained during each period were the same, showing consistency in conversation. In total, 6 broad themes were created: fatherhood thoughts, fatherhood celebrations, advice seeking, fatherhood announcements, external parties targeting fathers, and miscellaneous. CONCLUSIONS: Fathers use social media to make announcements, celebrate fatherhood, seek advice, and interact with other fathers. Others used social media to advertise baby products and promote baby-related resources for fathers. Overall, the arrival of the COVID-19 pandemic appeared to have little impact on the excitement and resiliency of new fathers as they transition to parenthood. Altogether, these findings provide insight and guidance on the ways in which public health professionals can rapidly gather information about special populations-such as new and expecting fathers via the web-to monitor their beliefs, attitudes, emotional reactions, and unique lived experiences in context (ie, throughout a global pandemic).

Contributions of Trustworthiness, Health Literacy, and Self-Efficacy in Communicating With COVID-19 Vaccine-Hesitant Audiences: Web-Based Survey Study.

BACKGROUND: Large-scale health communication challenges during the COVID-19 pandemic, such as widespread misinformation and distrust in health care professionals, have influenced reluctance to take the COVID-19 vaccine, also known as vaccine hesitancy. Trust in health professionals, adequate health literacy, and high self-efficacy are key components of actively pursuing preventative and protective health care measures. These factors may be associated with intentions to seek and complete a COVID-19 vaccine dosing. OBJECTIVE: The objective of this analysis was to identify factors associated with COVID-19 vaccine hesitancy. METHODS: In February 2021, US adults (N=5872) responded to a web-based survey on COVID-19 vaccine hesitancy and components of health communication (trust in sources of health information, health literacy, and self-efficacy). Multivariable logistic regression models were used to explore associations between these factors and vaccine hesitancy while adjusting for key demographics. We hypothesized that low levels of trust, health literacy, and self-efficacy would be associated with increased vaccine hesitancy. RESULTS: The adjusted odds of vaccine hesitancy was greater among those who placed little to no trust in health professionals compared to those who held a lot of trust (adjusted odds ratio [AOR] 8.54, 95% CI 6.52-11.19). The odds of vaccine hesitancy was also greater among those who felt frustrated about finding health information compared to those who did not (AOR 2.10, 95% CI 1.62-2.70). Participants who had little to no confidence in receiving health advice or information had greater odds of vaccine hesitancy compared to those who had a lot of confidence (AOR 3.05, 95% CI 2.34-3.97). CONCLUSIONS: This study underscores the importance of trust between health professionals and their patients, and a need for improving health literacy regarding vaccines. Perceptions of mistrust and low levels of health literacy were associated with high levels of vaccine hesitancy, providing empirical support of framing these factors as perceived barriers to vaccine uptake.

Psychosocial correlates of face-touching mitigation behaviors in public and private.

This study investigates psychosocial factors that influence people's face-touching mitigation behaviors. A nationwide survey was conducted online, and the results showed that perceived risk severity of touching face, and barriers and self-efficacy of not touching face were stable predictors. COVID-19 was related to a higher likelihood of mitigation behavior in public spaces. This study provides important implications to health communication and promotion for COVID-19 and general infection control.

Mobile Apps as Audience-Centered Health Communication Platforms.

Health communication campaigns often suffer from the shortcomings of a limited budget and limited reach, resulting in a limited impact. This paper suggests a shift of these campaigns to audience-centered communication platforms-particularly, apps on mobile phones. By using a common platform, multiple interventions and campaigns can combine resources and increase user engagement, resulting in a larger impact on health behavior. Given the widespread use of mobile phones, mobile apps can be an effective and efficient tool to provide health interventions. One such platform is Father's Playbook, a mobile app designed to encourage men to be more involved during their partner's pregnancy. Health campaigns and interventions looking to reach expectant fathers can use Father's Playbook as a vehicle for their messages.

Time to Follow-up After Colorectal Cancer Screening by Health Insurance Type.

INTRODUCTION: The purpose of this study was to test the hypothesis that patients with Medicaid insurance or Medicaid-like coverage would have longer times to follow-up and be less likely to complete colonoscopy compared with patients with commercial insurance within the same healthcare systems. METHODS: A total of 35,009 patients aged 50-64years with a positive fecal immunochemical test were evaluated in Northern and Southern California Kaiser Permanente systems and in a North Texas safety-net system between 2011 and 2012. Kaplan-Meier estimation was used between 2016 and 2017 to calculate the probability of having follow-up colonoscopy by coverage type. Among Kaiser Permanente patients, Cox regression was used to estimate hazard ratios and 95% CIs for the association between coverage type and receipt of follow-up, adjusting for sociodemographics and health status. RESULTS: Even within the same integrated system with organized follow-up, patients with Medicaid were 24% less likely to complete follow-up as those with commercial insurance. Percentage receiving colonoscopy within 3 months after a positive fecal immunochemical test was 74.6% for commercial insurance, 63.10% for Medicaid only, and 37.5% for patients served by the integrated safety-net system. CONCLUSIONS: This study found that patients with Medicaid were less likely than those with commercial insurance to complete follow-up colonoscopy after a positive fecal immunochemical test and had longer average times to follow-up. With the future of coverage mechanisms uncertain, it is important and timely to assess influences of health insurance coverage on likelihood of follow-up colonoscopy and identify potential disparities in screening completion.

Selective Estrogen Receptor ß Agonist LY500307 as a Novel Therapeutic Agent for Glioblastoma.

Glioblastomas (GBM), deadly brain tumors, have greater incidence in males than females. Epidemiological evidence supports a tumor suppressive role of estrogen; however, estrogen as a potential therapy for GBM is limited due to safety concerns. Since GBM express ERß, a second receptor for estrogen, targeting ERß with a selective agonist may be a potential novel GBM therapy. In the present study, we examined the therapeutic effect of the selective synthetic ERß agonist LY500307 using in vitro and in vivo GBM models. Treatment with LY500307 significantly reduced the proliferation of GBM cells with no activity on normal astrocytes in vitro. ERß agonists promoted apoptosis of GBM cells, and mechanistic studies using RNA sequencing revealed that LY500307 modulated several pathways related to apoptosis, cell cycle, and DNA damage response. Further, LY500307 sensitized GBM cells to several FDA-approved chemotherapeutic drugs including cisplatin, lomustine and temozolomide. LY500307 treatment significantly reduced the in vivo tumor growth and promoted apoptosis of GBM tumors in an orthotopic model and improved the overall survival of tumor-bearing mice in the GL26 syngeneic glioma model. Our results demonstrate that LY500307 has potential as a therapeutic agent for GBM.