Cervical Cancer Screening Barriers and Risk Factor Knowledge Among Uninsured Women.

A steady decline in cervical cancer incidence and mortality in the United States has been attributed to increased uptake of cervical cancer screening tests such as Papanicolau (Pap) tests. However, disparities in Pap test compliance exist, and may be due in part to perceived barriers or lack of knowledge about risk factors for cervical cancer. This study aimed to assess correlates of cervical cancer risk factor knowledge and examine socio-demographic predictors of self-reported barriers to screening among a group of low-income uninsured women. Survey and procedure data from 433 women, who received grant-funded cervical cancer screenings over a span of 33 months, were examined for this project. Data included demographics, knowledge of risk factors, and agreement on potential barriers to screening. Descriptive analysis showed significant correlation between educational attainment and knowledge of risk factors (r = 0.1381, P < 0.01). Multivariate analyses revealed that compared to Whites, Hispanics had increased odds of identifying fear of finding cancer (OR 1.56, 95% CI 1.00-2.43), language barriers (OR 4.72, 95% CI 2.62-8.50), and male physicians (OR 2.16, 95% CI 1.32-3.55) as barriers. Hispanics (OR 1.99, 95% CI 1.16-3.44) and Blacks (OR 2.06, 95% CI 1.15-3.68) had a two-fold increase in odds of agreeing that lack of knowledge was a barrier. Identified barriers varied with age, marital status and previous screening. Programs aimed at conducting free or subsidized screenings for medically underserved women should include culturally relevant education and patient care in order to reduce barriers and improve screening compliance for safety-net populations.

The cost-effectiveness of training US primary care physicians to conduct colorectal cancer screening in family medicine residency programs.

BACKGROUND: Demand for a wide array of colorectal cancer screening strategies continues to outpace supply. One strategy to reduce this deficit is to dramatically increase the number of primary care physicians who are trained and supportive of performing office-based colonoscopies or flexible sigmoidoscopies. This study evaluates the clinical and economic implications of training primary care physicians via family medicine residency programs to offer colorectal cancer screening services as an in-office procedure. METHODS: Using previously established clinical and economic assumptions from existing literature and budget data from a local grant (2013), incremental cost-effectiveness ratios are calculated that incorporate the costs of a proposed national training program and subsequent improvements in patient compliance. Sensitivity analyses are also conducted. RESULTS: Baseline assumptions suggest that the intervention would produce 2394 newly trained residents who could perform 71,820 additional colonoscopies or 119,700 additional flexible sigmoidoscopies after ten years. Despite high costs associated with the national training program, incremental cost-effectiveness ratios remain well below standard willingness-to-pay thresholds under base case assumptions. Interestingly, the status quo hierarchy of preferred screening strategies is disrupted by the proposed intervention. CONCLUSIONS: A national overhaul of family medicine residency programs offering training for colorectal cancer screening yields satisfactory incremental cost-effectiveness ratios. However, the model places high expectations on primary care physicians to improve current compliance levels in the US.

Determinants of variations in self-reported barriers to colonoscopy among uninsured patients in a primary care setting.

Colorectal cancer (CRC) is the third most common type of cancer among both males and females in the United States and the second leading cause of cancer-related deaths. Although largely preventable through screening, early detection and removal of polyps, screening rates are considered sub-optimal. Perceived barriers to screening have been reported to influence screening rates. This paper examines variations in the extent to which uninsured patients identified barriers to CRC screening using colonoscopy based on race/ethnicity, educational attainment, age, gender, marital status and prior colonoscopy. Multivariate analyses showed that compared to Caucasians, African Americans had an increased likelihood of identifying lack of transportation as a barrier [odds ratio (OR) 2.68; 95 % confidence interval (CI) 1.35-5.32] while Hispanics were more likely to identify fear of finding cancer as a barrier (OR 2.09; 95 % CI 1.19-3.66). Compared to those with more than a high school education, there was increased likelihood of identifying lack of knowledge as a barrier among individuals with high school education (OR 3.51; 95 % CI 1.94-6.36) or less than a high school education (OR 2.16; 95 % CI 1.04-4.50). Our findings suggest that strategies aimed at increasing colonoscopy screening rates among underserved populations should take into consideration race/ethnicity, educational attainment, age, and prior colonoscopy experience when developing education and outreach plans to reduce barriers to colonoscopy.

Behavioral and technological interventions targeting glycemic control in a racially/ethnically diverse population: a randomized controlled trial.

BACKGROUND: Diabetes self-care by patients has been shown to assist in the reduction of disease severity and associated medical costs. We compared the effectiveness of two different diabetes self-care interventions on glycemic control in a racially/ethnically diverse population. We also explored whether reductions in glycated hemoglobin (HbA1c) will be more marked in minority persons. METHODS: We conducted an open-label randomized controlled trial of 376 patients with type 2 diabetes aged ≥18 years and whose last measured HbA1c was ≥7.5% (≥58 mmol/mol). Participants were randomized to: 1) a Chronic Disease Self-Management Program (CDSMP; n = 101); 2) a diabetes self-care software on a personal digital assistant (PDA; n = 81); 3) a combination of interventions (CDSMP + PDA; n = 99); or 4) usual care (control; n = 95). Enrollment occurred January 2009-June 2011 at seven regional clinics of a university-affiliated multi-specialty group practice. The primary outcome was change in HbA1c from randomization to 12 months. Data were analyzed using a multilevel statistical model. RESULTS: Average baseline HbA1c in the CDSMP, PDA, CDSMP + PDA, and control arms were 9.4%, 9.3%, 9.2%, and 9.2%, respectively. HbA1c reductions at 12 months for the groups averaged 1.1%, 0.7%, 1.1%, and 0.7%, respectively and did not differ significantly from baseline based on the model (P = .771). Besides the participants in the PDA group reporting eating more high-fat foods compared to their counterparts (P < .004), no other significant differences were observed in participants' diabetes self-care activities. Exploratory sub-analysis did not reveal any marked reductions in HbA1c for minority persons but rather modest reductions for all racial/ethnic groups. CONCLUSIONS: Although behavioral and technological interventions can result in some modest improvements in glycemic control, these interventions did not fare significantly better than usual care in achieving glycemic control. More research is needed to understand how these interventions can be most effective in clinical practice. The reduction in HbA1c levels found in our control group that received usual care also suggests that good routine care in an integrated healthcare system can lead to better glycemic control. TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT01221090.

The Impact of Immigration Policy Changes on Preterm Birth Rates in Texas: An Examination of Border and Nonborder Regions.

BACKGROUND: Our study examined the acute and sustained impact of immigration policy changes announced in January 2017 on preterm birth (PTB) rates among Hispanic and non-Hispanic white women in Texas's border and nonborder regions. METHODS: Using Texas birth certificate data for years 2008 through 2020, we used a multiple group interrupted time series approach to explore changes in PTB rates. RESULTS: In the nonborder region, the PTB rate among Hispanic women of any race was 8.64% in 2008 and was stable each year before 2017 but increased by .29% (95% CI [.12, .46]) annually between 2017 and 2020. This effect remained statistically significant even when compared with that of non-Hispanic white women (p = .014). In the border areas, the PTB rate among Hispanic women of any race was 11.67% in 2008 and remained stable each year before and after 2017. No significant changes were observed when compared with that of non-Hispanic white women (p = .897). In Texas as a whole, the PTB rate among Hispanic women of any race was 10.16% in 2008 and declined by .07% (95% CI [-.16, -.03]) per year before 2017, but increased by .16% (95% CI [.05, .27]) annually between 2017 and 2020. The observed increase was not statistically significant when compared with that of non-Hispanic white women (p = .326). CONCLUSIONS: The January 2017 immigration policies were associated with a sustained increase in PTB among Hispanic women in Texas's nonborder region, suggesting that geography plays an important role in perceptions of immigration enforcement. Future research should examine the impact of immigration policies on maternal and child health, considering geography and sociodemographic factors.

Factors associated with successful completion of the chronic disease self-management program by adults with type 2 diabetes.

This study examines factors associated with completion (attendance ≥4 of 6 sessions) of the Chronic Disease Self-Management Program (CDSMP) by adults with type 2 diabetes. Patients with glycated hemoglobin ≥ 7.5 within 6 months were enrolled and completed self-report measures on demographics, health status, and self-care (n = 146). Significant differences in completion status were found for several self-care factors including healthful eating plan, spacing carbohydrates, frequent exercise, and general health. Completion was not influenced by race/ethnicity or socioeconomics. Results suggest better attention to exercise and nutrition at the start of CDSMP may be associated with completion, regardless of demographic subgroup.

Dental hygienists' scope of practice regulations and preventable non-traumatic dental emergency department visits: A cross-sectional study of 10 U.S. states.

OBJECTIVES: As emergency department (ED) visits for non-traumatic dental complaints continue to rise in the United States (U.S.), some states are implementing initiatives to expand access to the oral health workforce. This study examines the associations between the 2014 Dental Hygiene Professional Practice Index (DHPPI) and preventable dental ED visits. METHODS: In 2020, we used ED data from 10 U.S. states and ordinary least squares models to examine the relationship between the states' DHPPI scores and preventable dental ED use. We stratified regressions by age to examine this relationship across different age cohorts and introduced interaction terms to assess the same relationship among rural and urban residents. RESULTS: On average, 23.8% of all non-traumatic dental ED visits were identified as preventable. Controlling for other factors, a one-point increase in DHPPI scores was associated with a decrease of 0.01 (95% CI -0.03, -0.02) preventable dental ED visits per 1000 county population in each year-quarter. In the age-stratified models, the strength of the association between DHPPI scores and preventable dental ED visits was higher in the 20 to 34 (-0.03, 95% CI -0.04, -0.02), and the 35 to 50 age cohorts (-0.17, 95% CI -0.00, -0.00). U.S. states with DHPPI scores below 60 saw significantly higher preventable dental ED visits among rural residents. CONCLUSIONS: This study demonstrates that stringent state policies regarding the dental hygienist workforce are associated with higher preventable dental ED visits in the U.S. Policy makers and stake holders must address the scope of practice policies to alleviate the burden of access to oral healthcare.

Rural healthy people 2030: New decade, new challenges.

Rural Healthy People is a companion piece to the federal Healthy People initiative released once a decade to identify the most important Healthy People priorities for rural America, as identified by rural stakeholders, for the current decade. This study reports on the findings of Rural Healthy People 2030. The study relied on a survey of rural health stakeholders collected from July 12, 2021, to February 14, 2022, and: 1) identified the 20 Healthy People priorities most frequently selected as priorities for rural America, 2) studied the priorities that were most frequently selected as a "top 3" priority within each Healthy People 2030 category, and 3) investigated Healthy People 2030 priorities in terms of ranked importance for rural Americans. The analysis finds that for the first time across 3 decades of Rural Healthy People, a greater proportion of respondents selected "Mental Health and Mental Disorders" and "Addiction" as Healthy People priorities for rural America, than did "Health Care Access and Quality". Even still, respondents ranked "Health Care Access and Quality" as the single-most important rural priority. "Economic Stability," a new priority within the Social Determinant of Health category, debuted within the 10 most frequently selected priorities for rural America for the coming decade. As public health practitioners, researchers, and policymakers work toward closing the urban-rural divide, the most important rural priorities to address in the coming decade are mental health and substance use disorders, access to high quality health care services, and social determinants of health, such as economic stability.

Cervical Cancer Screening Outcomes Among a Sample of Low-Income Uninsured Women: A Program-Based Study.

Background: Most studies examining cervical cancer screening outcomes have focused on either an age-specific diagnosis and outcomes of abnormal smears or frequency of abnormal outcomes among a sample of insured women. Thus, it is unclear what the distribution outcomes would be when other sociodemographic characteristics are considered. This study examines the variation in cervical cancer screening outcomes and sociodemographic characteristics (patients' age, marital status, race/ethnicity, rurality, and Papanicolaou [Pap] test screening history) within a sample of low-income and uninsured women. Materials and Methods: Our grant-funded program provided 751 Pap tests, 577 human papillomavirus (HPV) tests, and 262 colposcopies to 841 women between 2013 and 2019. Observed outcomes for each procedure type were cross-tabulated by patients' sociodemographic characteristics. Chi-squared and Fisher's exact tests were used to test the independence of screening outcomes and sociodemographic characteristics. Results: The overall positivity rate was 7.2% for Pap tests (n = 54/751), 3.6% for HPV tests (n = 21/577), and 44.7% for colposcopies (n = 117/262). Significance tests suggested that the Pap test and colposcopy outcomes we observed were independent of sociodemographic characteristics in all but one instance-Pap test outcomes were not independent of patient age (p = 0.009). Moreover, the Pap test positivity rate increased with patient age. Conclusions: Our findings support recommendations to discontinue screening for women older than 65 years at low risk for cervical cancer. Our ability to identify an association between cervical screening outcomes and other sociodemographic characteristics may have been limited by our small sample size. This highlights an important barrier to studying health outcomes within low-income and uninsured populations, which are often missing in larger research data sets (e.g., claims).

Patient-centered medical homes: will health care reform provide new options for rural communities and providers?

Many are calling for the expansion of the patient-centered medical home model into rural and underserved populations as a transformative strategy to address issues of access, efficiency, quality, and sustainability in the delivery of health care. Patient-centered medical homes have been touted as a promising cost-saving model for comprehensive management of persons with chronic diseases and disabilities, but it is unclear how rural practitioners in medically underserved areas will implement the patient-centered medical home. This article examines how the Patient Protection & Affordable Care Act of 2010 will enhance rural providers' ability to provide patient-centered care and services contemplated under the Act in a comprehensive, coordinated, cost-effective way despite leaner budgets and health workforce shortages.

Mammography Screening Beliefs and Knowledge among a Multi-ethnic Sample of Low-income, Uninsured Women.

The purpose of this study was to examine screening mammography prevalence and its associated beliefs among a multi-ethnic sample of low-income, uninsured women. Data pertaining to the sample's demographic characteristics, mammography screening history and beliefs, and knowledge on recommended screening age were analyzed (n=533). Overall, 22.1% of the participants had never been screened. Black women were more likely than others to have never been screened, White women were more likely to be overdue, and Hispanic women were more likely to report recent screening. Fear of not knowing what will be done during mammography consistently predicted screening among the racial/ethnic groups. Concerns about "people doing mammograms being rude to women" had the highest negative correlation with mammography among Hispanic women. A majority of the sample believed that screening should begin at age 40. Interventions to increase screening mammography must incorporate information about the screening procedure and be sensitive to cultural differences in screening barriers.

Factors Affecting Adoption of a Technology-Based Tool for Diabetes Self-Management Education and Support Among Adult Patients with Type 2 Diabetes in South Texas.

PURPOSE: The purpose of this study is to describe a novel computerized diabetes education tool and explore factors influencing self-selection and use among primarily Hispanic patients diagnosed with type 2 diabetes in south Texas. METHODS: Study participants included 953 adult patients with type 2 diabetes enrolled in a diabetes education program between July 1, 2016, and June 30, 2017. Participants were asked to choose either a new technology-based diabetes education tool with a touch-screen device or a traditional face-to-face education method. Multivariate logistic regression analysis was applied to identify factors associated with adopting the computerized diabetes education tool among the patients. RESULTS: When comparing technology-based tool adopters and nonadopters, several demographic and health-related factors differentiated technology use in bivariate analyses. The multivariate logistic regression model showed that Hispanic patients were less likely to choose a technology-based tool. Patients who perceived their health status as excellent/good were more likely to adopt the technologic education method than those with fair/poor perceived health status. A1C level was negatively associated with self-selection of technology. CONCLUSIONS: Specific demographic and health-related characteristics are significant contributing factors to patients' adoption of a technology-based diabetes education tool. Health care providers can utilize these findings to target and refer specific patients to a computerized diabetes education tool for more effective diabetes care and to optimize technology adoption success.

Racial, Rural, and Regional Disparities in Diabetes-Related Lower-Extremity Amputation Rates, 2009-2017.

OBJECTIVE: To examine the racial/ethnic, rural-urban, and regional variations in the trends of diabetes-related lower-extremity amputations (LEAs) among hospitalized U.S. adults from 2009 to 2017. RESEARCH DESIGN AND METHODS: We used the National Inpatient Sample (NIS) (2009-2017) to identify trends in LEA rates among those primarily hospitalized for diabetes in the U.S. We conducted multivariable logistic regressions to identify individuals at risk for LEA based on race/ethnicity, census region location (North, Midwest, South, and West), and rurality of residence. RESULTS: From 2009 to 2017, the rates of minor LEAs increased across all racial/ethnic, rural/urban, and census region categories. The increase in minor LEAs was driven by Native Americans (annual percent change [APC] 7.1%, P < 0.001) and Asians/Pacific Islanders (APC 7.8%, P < 0.001). Residents of non-core (APC 5.4%, P < 0.001) and large central metropolitan areas (APC 5.5%, P < 0.001) experienced the highest increases over time in minor LEA rates. Among Whites and residents of the Midwest and non-core and small metropolitan areas there was a significant increase in major LEAs. Regression findings showed that Native Americans and Hispanics were more likely to have a minor or major LEA compared with Whites. The odds of a major LEA increased with rurality and was also higher among residents of the South than among those of the Northeast. A steep decline in major-to-minor amputation ratios was observed, especially among Native Americans. CONCLUSIONS: Despite increased risk of diabetes-related lower-limb amputations in underserved groups, our findings are promising when the major-to-minor amputation ratio is considered.

The association between rurality, sociodemographic characteristics, and mammogram screening outcomes among a sample of low-income uninsured women.

Studies have found a positive association between adherence to mammography screening guidelines and early detection of breast cancer lesions, yet the proportion of women who get screened for breast cancer remains below national targets. Previous studies have found that mammography screening rates vary by sociodemographic factors including race/ethnicity, income, education, and rurality. It is less known whether sociodemographic factors are also related to mammography screening outcomes in underserved populations. Thus, with a particular interest in rurality, we examined the association between the sociodemographic characteristics and mammography screening outcomes within our sample of 1,419 low-income, uninsured Texas women who received grant-funded mammograms between 2013 and 2019 (n = 1,419). Screening outcomes were recorded as either negative (Breast Imaging Reporting and Data System (BI-RADS) classification 1-3) or positive (BI-RADS classification 4-6). When we conducted independency tests between sociodemographic characteristics (age, race/ethnicity, rurality, county-level risk, family history, and screening compliance) and screening outcomes, we found that none of the factors were significantly associated with mammogram screening outcomes. Similarly, when we regressed screening outcomes on age, race/ethnicity, and rurality via logistic regression, we found that none were significant predictors of a positive screening outcome. Though we did not find evidence of a relationship between rurality and mammography screening outcomes, research suggests that among women who do screen positive for breast cancer, rural women are more likely to present with later stage breast cancer than urban women. Thus, it remains important to continue to increase breast cancer education and access to routine cancer screening for rural women.

Factors affecting the likelihood of a hospitalization following a diabetes-related emergency department visit: A regional and urban-rural analysis.

BACKGROUND: The objective of this study is to examine place-based and individual-level predictors of diabetes-related hospitalizations that stem from emergency department (ED) visits. METHODS: We conducted a pooled cross-sectional analysis of the National Inpatient Sample (NIS) for 2009 to 2014 to identify ED-initiated hospitalizations that were driven by the need for diabetes care. The odds of an ED-initiated diabetes-related hospitalization were assessed for the United States as a whole and separately for each census region. RESULTS: Nationally, residents of noncore areas (odds ratio [OR] 1.10; CI 1.08, 1.12), the South (OR 8.03; CI 6.84, 9.42), Blacks (OR 2.49; CI 2.47, 2.52), Hispanics (OR 2.32; CI 2.29, 2.35), Asians or Pacific Islanders (OR 1.20; CI 1.16, 1.23), Native Americans (OR 2.18; CI 2.10, 2.27), and the uninsured (OR 2.14; CI 2.11, 2.27) were significantly more likely to experience an ED-initiated hospitalization for diabetes care. Census region-stratified models showed that noncore residents of the South (OR 1.17; CI 1.14, 1.20) and Midwest (OR 1.06; CI 1.02, 1.11) had higher odds of a diabetes-related ED-initiated hospitalization. CONCLUSIONS: As continued efforts are made to reduce place-based disparities in diabetes care and management, targeted focus should be placed on residents of noncore areas in the South and Midwest, racial and ethnic minorities, as well as the uninsured population.

Effect of Study Design and Survey Instrument to Identify the Association Between Depressive Symptoms and Physical Activity in Type 2 Diabetes, 2000-2018: A Systematic Review.

INTRODUCTION: Previous studies have used a variety of survey measurement options for evaluating the association between physical activity (PA) and depressive symptoms, raising questions about the types of instruments and their effect on the association. This study aimed to identify measures of PA and depressive symptoms and findings of their association given diverse instruments and study characteristics in type 2 diabetes (T2DM). METHODS: Online databases, Medline, Embase, CINAHL, and PsycINFO were searched on July 20, 2018, and January 8, 2019. Our systematic review included observational studies from 2000 to 2018 that investigated the association between PA and depressive symptoms in T2DM. RESULTS: Of 2294 retrieved articles, 28 studies were retained in a focused examination and comparison of the instruments used. There were a range of standard measures, 10 for depressive symptoms and 7 for PA, respectively. Patient Health Questionnaire (PHQ) for depressive symptoms and study-specific methods for PA were the most popular. Overall, 71.9% found a significant association between PA and depressive symptoms. Among studies classified as high quality or reliability, the figure was 81.8%. CONCLUSION: A majority of the sample found an association between depressive symptoms and PA, which is fairly consistent across study characteristics. The findings provide the evidence for the health benefits of PA on reducing depressive symptoms in persons with T2DM, suggesting active engagement in PA for effective diabetes management. However, guidelines for objective measurements and well-designed prospective studies are needed to strengthen the evidence base and rigor for the association and its directionality.

The Impact of Medicaid Expansion on Diabetes Management.

OBJECTIVE: Diabetes is a chronic health condition contributing to a substantial burden of disease. According to the Robert Wood Johnson Foundation, 10.9 million people were newly insured by Medicaid between 2013 and 2016. Considering this coverage expansion, the Affordable Care Act (ACA) could significantly affect people with diabetes in their management of the disease. This study evaluates the impact of the Medicaid expansion under the ACA on diabetes management. RESEARCH DESIGN AND METHODS: This study includes 22,335 individuals with diagnosed diabetes from the 2011 to 2016 Behavioral Risk Factor Surveillance System. It uses a difference-in-differences approach to evaluate the impact of the Medicaid expansion on self-reported access to health care, self-reported diabetes management, and self-reported health status. Additionally, it performs a triple-differences analysis to compare the impact between Medicaid expansion and nonexpansion states considering diabetes rates of the states. RESULTS: Significant improvements in Medicaid expansion states as compared with non-Medicaid expansion states were evident in self-reported access to health care (0.09 score; P = 0.023), diabetes management (1.91 score; P = 0.001), and health status (0.10 score; P = 0.026). Among states with large populations with diabetes, states that expanded Medicaid reported substantial improvements in these areas in comparison with those that did not expand. CONCLUSIONS: The Medicaid expansion has significant positive effects on self-reported diabetes management. While states with large diabetes populations that expanded Medicaid have experienced substantial improvements in self-reported diabetes management, non-Medicaid expansion states with high diabetes rates may be facing health inequalities. The findings provide policy implications for the diabetes care community and policy makers.

Assessing diabetes practices in clinical settings: precursor to building community partnerships around disease management.

Many recommended best practices exist for clinical and community diabetes management and prevention. However, in many cases, these recommendations are not being fully utilized. It is useful to gain a sense of currently utilized and needed practices when beginning a partnership building effort to ameliorate such practice problems. The purpose of this study was to assess current practices in clinical settings within the Brazos Valley in preparation for beginning a community-based participatory research project on improving diabetes prevention and management in this region. Fifty-seven physicians with admission privileges to a regional health system were faxed a survey related to current diabetes patient loads, knowledge and implementation of diabetes-related best practices, and related topics. Both qualitative and quantitative examination of the data was conducted. Fifteen percent of responding providers indicated they implemented diabetes prevention best practices, with significant differences between primary-care physicians and specialists. Respondents indicated a need for educational and counseling resources, as well as an increased health-care workforce in the region. The utilization of a faxed-based survey proved an effective means for assessing baseline data as well as serving as a catalyst for further discussion around coalition development. Results indicated a strong need for both clinical and community-based services regarding diabetes prevention and management, and provided information and insight to begin focused community dialogue around diabetes prevention and management needs across the region. Other sites seeking to begin similar projects may benefit from a similar process.

Sociodemographic and healthcare characteristics of Colonia residents: the role of life stage in predicting health risks and diabetes status in a disadvantaged Hispanic population.

An assessment of the risk or diagnosis of diabetes in a random sample of 386 adult border residents found 46% obese, 12% at risk for diabetes, and 18% diagnosed with diabetes. While obesity was associated with greater diabetes risk, > 50% of obese adults reported not being told of their diabetes risk. Independent of other characteristics, boomers were at increased risk (OR 3.88) for diabetes. Comorbidities increased the risk for actual diabetes diagnosis (OR 4.79). Skipping medications increased risk of developing diabetes (OR 2.98). Disadvantaged obese boomers are at particular risk, warranting culturally appropriate interventions before onset of chronic illnesses.

The impact of interprofessional education on family nurse practitioner students' and family medicine residents' knowledge and confidence in screening for breast and cervical cancer.

BACKGROUND AND PURPOSE: This study determined the impact of an interprofessional education (IPE) simulation on family nurse practitioner (FNP) students' and family medicine residents' (FMRs) self-reported confidence in counseling women reluctant to engage in cancer screening or evaluation and assessed knowledge of breast and cervical cancer risk factors. METHOD: A multi-item knowledge survey on breast and cervical cancer risk factors was administered to 76 FNP students and FMRs followed by an IPE simulation with a pre-/postsurvey of self-reported confidence in counseling a woman reluctant to have breast and cervical cancer screening and evaluation. DISCUSSION: Data demonstrated knowledge deficits in breast and cervical cancer risk factors in both disciplines with the average risk factor knowledge score of 8.5/12 for breast cancer and 7.8/12 for cervical cancer. Following IPE simulation, confidence in counseling women reluctant to have breast or cervical cancer screening improved across both disciplines (p < .05) and debrief feedback findings suggest improved attitudes toward collegiality, communication, and understanding of other interprofessional roles among both disciplines. CONCLUSION: Knowledge gaps exist among both FNP students and FMRs in breast and cervical cancer risk factors. This study suggests IPE simulation is effective in building individual provider confidence and team collegiality.