Demographic, clinical and psychological predictors of malnutrition among people with liver cancer.

PURPOSE: This study aimed to explore the nutritional status and examine the demographic, clinical, nutritional, and psychosocial characteristics associated with malnutrition among people with liver cancer. METHODS: A descriptive cross-sectional design was used. Data were collected from a convenience sample of 162 liver cancer outpatients at a tertiary university hospital. Nutritional status was evaluated using the Patient-Generated Subjective Global Assessment (PG-SGA). Self-administered structured questionnaires were administered, and medical records were reviewed for demographic, clinical, nutritional, and psychosocial characteristics. RESULTS: Based on PG-SGA scores, 27 patients (16.7%) were classified into the malnutrition group. The stages of liver cancer, chemotherapy, physical and psychological symptom distress, global distress index, levels of alpha-fetoprotein and protein induced by vitamin K absence or antagonists, body mass index, appetite, hemoglobin and albumin levels, and depression were statistically significantly associated with malnutrition. Logistic regression model revealed that physical symptom distress, liver cancer stage, depression, and body mass index influenced statistically significantly malnutrition. CONCLUSIONS: In this study, clinical, nutritional, and psychosocial characteristics predicted malnutrition among people with liver cancer. Nurses should consider these characteristics when evaluating the nutritional status of people with liver cancer.

Software-based interventions for low back pain management: A systematic review and meta-analysis.

INTRODUCTION: Using software for self-management interventions can improve health outcomes for individuals with low back pain, but there is a dearth of research to confirm its effectiveness. Additionally, no known research has evaluated the effective elements of software-based interventions for low back pain self-management components. This study aimed to synthesize the effectiveness of software-based interventions to promote self-management health outcomes among individuals with low back pain. DESIGN: A systematic review and meta-analysis was conducted. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement, relevant studies up to July 2022 were searched via four electronic databases: PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, and Web of Science. RESULTS: 4908 adults with low back pain who participated in 23 studies were included. Software-based interventions were effective in reducing fear avoidance (mean difference [MD] = -0.95, 95% CI: -1.45 to -0.44), pain catastrophizing (MD = -1.31, 95% CI: -1.84 to -0.78), disability (MD = -8.21, 95% CI: -13.02 to -3.39), and pain intensity (MD = -0.86, 95% CI: -1.17 to -0.55). Specifically, interventions that included an exercise component were more effective in reducing pain and disability. Additionally, cognitive behavioral therapy (CBT) intervention significantly reduced fear avoidance and pain catastrophizing but had no noticeable impact on disability and pain compared to standard treatment. The certainty of the evidence in this review varied from very low to high across outcomes. The heterogeneity of the study results was significant, suggesting that future studies in this area could optimize the design, time points, measures, and outcomes to strengthen the evidence. CONCLUSIONS: Low back pain self-management interventions delivered through software-based programs effectively reduce pain intensity, disability, fear avoidance, and pain catastrophizing. CLINICAL RELEVANCE: Low back pain is among the most common reasons for seeking healthcare visits. Combining exercise and counseling through soft-based programs may effectively address this issue and its associated suffering and disability.

Health-promoting behavior among undergraduate students in the COVID-19 era: Its association with problematic use of social media, social isolation, and online health information-seeking behavior.

OBJECTIVE: To examine the association between problematic use of social media, online health information-seeking, social isolation, and health-promoting behaviors among Korean undergraduate students. METHODS: In total, 178 undergraduate students participated in this study. A multiple linear regression analysis was performed. RESULTS: Predictors of health-promoting behaviors included overall time spent on social media, problematic social media use, social isolation, and online information-seeking, explaining 33.5 % of the variance in health-promoting behaviors. CONCLUSION: Prolonged social media use and social isolation negatively affected undergraduate students' health-promoting behaviors, while online information-seeking positively affected them. Nurses should assist young adults in improving health-promoting behaviors by preventing problematic social media uses, reducing social isolation, and strengthening their online health information-seeking ability.

Pathways Through Which Experience in Treatment Decision-Making Affects Health-Related Quality of Life in People with Chronic Conditions.

Patient engagement in treatment decision-making is essential to improve the health-related quality of life (HRQoL) of patients affected by chronic diseases. However, research on how decision-making patterns influence HRQoL is limited. This study investigated the paths linking patient experience in decision-making to HRQoL through healthcare accessibility and physical activity among a representative sample of adults with chronic diseases. Using a cross-sectional design, the data of 4,071 individuals with chronic diseases from the 2015 Korea National Health and Nutrition Examination Survey were analyzed. We used R to account for the complex survey design and weights and conducted structural equation modeling. The EuroQoL 5 Dimensions were used to assess HRQoL. About half of the participants reported that providers always offered sufficient encounter time (48.8%), used lay terms (60.4%), provided opportunities for questions (57.8%), and reflected patient opinions on treatment plans (57.8%). Healthcare accessibility completely mediated the association between patient experience in decision-making and HRQoL, whereas decision-making experiences directly affected HRQoL, not via physical activity. Clinicians should provide solid and tailored advice that entails benefits and detriments to achieve evidence-based decision-making. Programs to enhance access to after-hour healthcare should be considered to improve patients' HRQoL.

Pain self-management plus activity tracking and nurse-led support in adults with chronic low back pain: feasibility and acceptability of the problem-solving pain to enhance living well (PROPEL) intervention.

BACKGROUND: Chronic low back pain can lead to individual suffering, high medical expenditures, and impaired social well-being. Although the role of physical activity in pain management is well established, the underlying mechanisms of biological and clinical outcomes are unknown. This study aimed to assess the feasibility and acceptability of a pain self-management intervention, Problem-Solving Pain to Enhance Living Well, which employs wearable activity tracking technology and nurse consultations for people with chronic low back pain. METHODS: This one-arm longitudinal study recruited 40 adults aged 18-60 years with chronic low back pain. Over 12 weeks, participants watched 10 short video modules, wore activity trackers, and participated in nurse consultations every 2 weeks. At baseline and the 12-week follow-up, they completed study questionnaires, quantitative sensory testing, and blood sample collection. RESULTS: Forty participants were recruited, and their mean age was 29.8. Thirty-two participants completed the survey questionnaire, quantitative sensory testing, Fitbit activity tracker, and bi-weekly nurse consultation, and 25 completed the evaluation of biological markers. The overall satisfaction with the Problem-Solving Pain to Enhance Living Well video modules, nurse consultations, and Fitbit in pain management was rated as excellent. No adverse events were reported. Between the baseline and 12-week follow-up, there was a significant decrease in pain intensity and interference and an increase in the warm detection threshold at the pain site. CONCLUSIONS: Despite concerns about the participant burden due to multidimensional assessment and intensive education, the feasibility of the Problem-Solving Pain to Enhance Living Well intervention was favorable. Technology-based self-management interventions can offer personalized strategies by integrating pain phenotypes, genetic markers, and physical activity types affecting pain conditions. TRIAL REGISTRATION: This pilot study was registered with ClinicalTrials.gov [NCT03637998, August 20, 2018]. The first participant was enrolled on September 21, 2018.

Creating a Self-management Mobile Application for People With Chronic Low Back Pain: A Focus Group Study of Unmet Needs and Strategies.

Mobile health can fulfill the unmet needs of patients with chronic low back pain by recommending individualized management plans. Limited mobile applications have been developed based on the needs, preferences, and values relative to self-management of patients with chronic low back pain. This study aimed to explore the experience of patients with chronic low back pain and the desired content, designs, and features of a self-management application. We conducted five focus groups (N = 24). Participants provided feedback on draft contents and they also discussed the desired designs and features of an application while reviewing a low-fidelity prototype. Data were audio-recorded, transcribed verbatim, and analyzed using qualitative content analysis. Three categories and eight subcategories emerged. Participants: (1) confronted difficulties of their pain experience along with vicious cycles of pain and unmet needs; (2) acknowledged the importance of self-management as they lived with chronic low back pain and realized how to self-manage their pain; and (3) suggested ways to fulfill needs and preferences among patients with chronic low back pain. The nature of chronic low back pain causes disruptions well-being and requires constant management. Developing user-centered strategies to enhance knowledge and promote self-management among chronic low back pain patients is required.

The association between psychological factors and self-care in patients with heart failure: an integrative review.

AIMS: This integrative review aims to describe the current evidence concerning the relationship between a broad range of psychological factors (depression, depressive symptoms, anxiety, stress, and type-D personality) and self-care in patients with heart failure. METHODS AND RESULTS: Six electronic databases were searched and keywords were used to identify potential eligible studies published within the last 10 years. To be eligible, individuals with heart failure aged 18 years or older and who were included in any type of observational study that examined the association between psychological factors and self-care were considered. Twenty articles were included, and 16 of them reported that depression/depressive symptoms were associated with poorer self-care, after controlling for age, sex, education level, cardiac history, or comorbidities. Five studies found that self-care confidence/self-efficacy mediates the relationship between depression/depressive symptoms and self-care. The association between depression/depressive symptoms and self-care varied in assessment methods and statistical approaches. Seven studies showed an inverse association between anxiety and self-care. Four studies found a stronger association between self-care and depression compared with the relationship between self-care and other psychological factors. Stress and type-D personality were both associated with self-care in four studies. CONCLUSION: Depression/depressive symptoms and anxiety were found to be inversely associated with self-care in patients with heart failure. Depression exhibited a stronger impact on self-care than other psychological factors. Limited studies assessed stress and type-D personality; the results should be considered with caution. Further studies are warranted on different psychological factors and their underlying mechanisms in individuals with heart failure.

Associations Between Allergies, Walking, Sedentary Time, and Low Back Pain.

PURPOSE: To examine associations between allergies, low back pain (LBP), walking, and sedentary time in a representative sample of adults aged 50 years and older. DESIGN: A cross-sectional, correlational study. METHODS: We used the 2014-2015 Korean National Health and Nutrition Examination Survey. Allergies of interest included allergic rhinitis, asthma, and atopic dermatitis. Adequate walking was defined as walking five or more days per week. Sedentary time was categorized as <7 h vs. ≥7 h. Logistic regression was performed to examine the association between allergies and LBP, controlling for demographics and lifestyle. Subgroup analyses were conducted to investigate the role of walking and sedentary lifestyle in LBP among those with or without allergies. RESULTS: Of 4,897 respondents, 23.1% reported LBP. After controlling for covariates, individuals with allergies were 1.68 times more likely to have LBP than those without allergies. In the non-allergy group, those with inadequate walking and sedentary lifestyles were nearly twice as likely to report LBP than those with adequate walking and without sedentary lifestyles. However, this trend was not observed in the patients with allergy diagnoses. CONCLUSIONS: We confirmed associations between lifetime allergy diagnosis and LBP. A protective role of physical activity and non-sedentary lifestyle in LBP remained only among those without allergies. CLINICAL IMPLICATIONS: Nurses should emphasize the impact of allergies on LBP. The advantages of walking and non-sedentary lifestyles for preventing or relieving chronic conditions should be routinely included in patient education; however, their preventive role in LBP should be underscored for those without allergies.

A Vax4HPV Mobile Application for Parents of Human Papillomavirus Vaccine-Eligible Children: Iterative Formative Assessments.

Although the human papillomavirus vaccine is efficacious, 40% of 13-year-old adolescents have been vaccinated for human papillomavirus. Implementing theory-based, user-centered applications can address this suboptimal coverage. This formative usability test aimed to develop a theory-based, user-centered interface to stimulate and inform parents' decision making on human papillomavirus vaccination and to help them act upon that decision. Iterative formative assessments were conducted through four focus groups of parents of children aged 9 to 14 years (N = 15). Participants discussed the desired content and features of a vaccine for human papillomavirus smartphone application while reviewing application prototypes. The discussions were recorded, transcribed verbatim, and then underwent qualitative content analysis. Four of the discovered themes were related to the content desired by parents: sources of information, facilitators of human papillomavirus vaccination, addressing the reasons for vaccine hesitancy, and gender-neutral content. The remaining three themes concerned the application's desirable designs and features: clear and descriptive interfaces, accessibility to broad groups of end users, and closing the intention-behavior gap. The need for adolescent human papillomavirus vaccination was generally well received by participants. This study found that theory-based, user-centered applications offering directions to appropriate clinics and human papillomavirus vaccine recommendations offered by nurses, can mitigate hesitancy by providing information via preferred routes and closing intention-behavior gaps.

Pro-inflammatory diet associated with low back pain in adults aged 50 and older.

AIMS: To investigate the association between pro-inflammatory diets and low back pain in a nationally representative sample of Korean adults. BACKGROUND: Low back pain is one of the most common health issues. Evidence suggests a potential association between systemic inflammation and the development of low back pain, and the role of diet in mitigating the inflammation that, in turn, can alleviate low back pain. METHODS: This cross-sectional, correlational study used data from the 6th Korea National Health and Nutrition Examination Survey involving health interviews, examinations, and nutritional surveys. Dietary inflammatory index scores were generated based on 24-hour dietary recalls. Respondents were asked if they had experienced low back pain for at least 30 days in the past three months. Multiple logistic regression analyses were conducted to investigate the independent association between pro-inflammatory diets and low back pain. RESULTS: Of 7346 respondents, most participants were middle-aged, married, and non-/ex-smokers, lived in 2+ person households, consumed alcohol less than once a week, and had no allergies or underlying medical conditions. Respondents in the highest inflammatory diet quintile had nearly 0.25 higher odds of reporting low back pain than those in the lowest quintile (adjusted ORquintile5vs1: 1.25, 95%CI [1.01-1.54]; p = .043). CONCLUSIONS: Results from this study indicate a role of pro-inflammatory diets in the development of low back pain. Nurses can screen for those consuming pro-inflammatory foods, and thus, are vulnerable to back pain, and aid in the delivery of tailored nutritional education. Future studies should investigate how diet affects low back pain diagnosis and chronicity relative to pain phenotypes.

Perceived discrimination and physical activity mediate the associations between receiving a survivorship care plan and cancer pain.

BACKGROUND: Survivorship care plan helps improve the continuity of care and manage ongoing pain that affects up to 46% of cancer survivors by promoting health behaviors, including physical activity. However, perceived discrimination may decrease the likelihood of cancer survivors participating in physical activities and negatively influence their pain status. Thus, this study aimed to examine the mediating role of physical activity and perceived discrimination in the relationship between receiving a survivorship care plan and cancer pain. METHODS: This cross-sectional, correlational study utilized data from the 2012-2019 Behavioral Risk Factor Surveillance System. Analyses accounted for the complex survey design. Logistic regression was utilized to analyze the association among survivorship care plans, discrimination, physical activity, and pain. Generalized structural equation modeling was conducted to test a hypothesized model in which survivorship care plans and discrimination affect physical activity, and subsequently influence pain status. RESULTS: Forty-two and 81% of survivors reported receiving treatment summaries and follow-up care plans, respectively, and 8% experienced cancer pain. After controlling for covariates, the highest discrimination quintile was three times more likely to report cancer pain than the lowest quintile. While receiving follow-up care plans was positively related to cancer pain, respondents in the third- to fifth- quintiles were less likely to report cancer pain when receiving follow-up care plans than the first quintile respondents. Physical activity mediated the association between discrimination and cancer pain. CONCLUSIONS: Reverse relationships between receiving follow-up care plans and cancer pain existed; however, discrimination and physical activity mediated these relationships.

A systematic review of the association between health literacy and pain self-management.

OBJECTIVE: To synthesize the impact of health literacy on pain self-management contexts, processes, and outcomes. METHODS: This systematic review employed a narrative synthesis. We used databases, including PubMed and PsycINFO, and handsearching of the reference lists to identify articles published before December 2020. Pain self-management variables were chosen based on the Individual and Family Self-Management Theory. Quality was assessed using the National Institute of Health quality assessment tool for observational and cross-sectional studies. RESULTS: Twenty studies that included 6173 participants were used. Most studies measured functional domains of the health literacy concept. Twelve studies reported small to large associations between health literacy and pain knowledge, medication regimen adherence, or pain. Thirteen studies considered health literacy clinical risks in tailoring education, while seven viewed it as personal assets developed via education. CONCLUSIONS: Limited information on the contribution of health literacy to pain self-management context factors and processes exists. Current evidence was limited by a lack of temporality, theoretical basis, and a priori sample estimation. PRACTICE IMPLICATIONS: Using brief functional literacy scales in the clinical environment can be more practical. Identifying patients' literacy levels helps clinicians personalize education, which then promotes patients' knowledge of pain, medication regimen adherence, and pain control.

Self-Efficacy Survey Study of Pain Self-Management in Patients with Cancer.

BACKGROUND: Cancer pain prevalence remains high, and variance in self-efficacy for managing pain may explain why some patients experience greater pain severity. AIM: This study explored perceptions of self-efficacy in relation to cancer pain severity and treatment related characteristics. METHOD: A descriptive cross-sectional survey was administered to 50 cancer outpatients. Data analysis involved descriptive and correlational statistical analyses. RESULTS: Self-efficacy to manage pain was significantly associated with time since diagnosis and ability to deal with frustration, and inversely associated with pain severity level. A large proportion of patients reported low satisfaction self-managing their pain. Most patients reported independently self-managing their cancer pain; however, satisfaction with pain management was low for a large proportion of patients. Time since cancer diagnosis and ability to deal with frustration due to cancer pain were positively associated with cancer pain self-efficacy, whereas pain self-efficacy had a significant inverse correlation with cancer pain severity. CONCLUSIONS: Enhancing self-efficacy to self-manage under-treated cancer pain is important with implications for improving pain outcomes and quality of life. Further investigation on unmet needs and preferences for cancer pain self-management support is warranted.

Patient and provider perspectives on patient-centered chronic pain management.

BACKGROUND: Fifty million American adults have chronic pain, and nearly 20 million have high-impact, or disabling, chronic pain, with higher prevalence associated with advancing age. Patient-centered pain management has been cited as a national priority to ensure that patient values and preferences guide clinical decisions. However, explicit, and practical strategies for implementing patient-centered pain management have not been disseminated. AIMS: The aim of this study was to elicit perceptions, beliefs, and experiences of patient-centered pain management among adults with chronic pain as well as among providers that could be used to develop recommendations for implementation and evaluation of patient-centered pain management. DESIGN: A descriptive qualitative study. SETTINGS/PARTICIPANTS: Fourteen adults with chronic pain were recruited from the communities. Besides, five providers caring for patients with chronic pain at an outpatient spine center affiliated to one academic hospital joined this study. METHODS: Each focus group lasted about 1 hour, which was recorded and transcribed verbatim. Data were analyzed using Erlingsson and Brysiewicz's content analysis to identify themes and develop recommendations. RESULTS: Four overarching themes emerged, including: (1) patient and (2) provider characteristics affecting patient-centered pain management; (3) processes and (4) outcomes of patient-centered pain management. We also visually depicted the determinants, processes, and outcomes of patient-centered pain management among providers and individuals with chronic pain. CONCLUSIONS: Patients emphasized their desire for a provider that listens, genuinely cares, and sees them holistically to provide the best individual and tailored care for them. Providers focused on setting realistic expectations, vocalizing the significance of pain education at a young age, and balancing patient satisfaction and opioid prescriptions. While patients can be empowered to self-manage their chronic pain due to patient-centered pain care, provider mental exhaustion and mistrust of providers among patients resulted from suboptimal pain management.

Associations among marijuana use, health-related quality of life, exercise, depression and sleep in cancer survivors.

AIMS: To assess associations among cannabis use, health-related quality of life, exercise, depression and sleep among a nationally representative sample of US adults living with cancer. DESIGN: A cross-sectional correlational study. METHODS: We used survey data from the 2016-2018 Behavioral Risk Factor Surveillance System. Analyses were considered for sample weights and the complex designs. Logistic regression was performed to assess associations among cannabis use (0, 1-19, vs. 20-30 [frequent] days), health-related quality of life (0-13 vs. ≥14 mentally or physically unhealthy days in the past 30 days; 0-13 vs. ≥14 functionally limited days), exercise, depression, and sleep after accounting for covariates. Reason for cannabis use (medical vs. non-medical) was also assessed. RESULTS: Frequent users had significantly more physically unhealthy days (adjusted odds ratio [OR]: 1.79, 95% CI: 1.28-2.51, p < .01) and reported ≥ 14 mentally unhealthy days (adjusted OR: 2.43, 95% CI: 1.78-3.32, p < .001) and depression (adjusted OR: 2.65, 95% CI: 1.97-3.57, p < .001) compared with non-users. A positive relationship between frequency of cannabis use and depression existed only among non-medical cannabis users. CONCLUSION: Cancer survivors using cannabis frequently (20 days+ in the past month) had poorer mental health-related quality of life. The reason for cannabis use as well as frequency of use may be important considerations in predicting depression. IMPACT: This is the first study that evaluates the associations among cannabis use, the purpose of cannabis use, HRQoL, exercise, depression and sleep in a nationally representative sample of US adults living with cancer. Frequent cannabis users are likely vulnerable to poorer mental health-related quality of life and depression, and non-medical cannabis use in frequent users was associated with depression. Given expanding medical cannabis legalization, these findings warrant further attention so that this information can be used by people living with cancer in decision-making for symptom self-management.

Age at Human Papillomavirus Vaccine Initiation Among Adolescents and Young Adults From 22 Pediatric Practices in the Northeastern United States.

PURPOSE: To examine trends in human papillomavirus (HPV) vaccine initiation and its determinants. DESIGN: This retrospective correlational study involved 12,260 individuals born between 1996 and 2000 receiving care from one of 22 pediatric practices in the northeastern region of the United States between 2016 and 2017. METHODS: We extracted data about HPV vaccination status and date, birth year, race, ethnicity, language, and geographic regions. Mean age at initiation was estimated using descriptive statistics. Multiple linear regression with weighted least squares was used to examine its correlates. FINDINGS: Of 12,260 individuals, about 76% initiated the HPV vaccination series at 9 to 17 years of age. While the initiation age decreased overall for both females and males (e.g., 14.3 vs. 16.2 years and 13.8 vs. 14.4 years in the 1996 vs. 2000 birth cohorts, respectively), a greater reduction was noted for males. Individuals tended to delay initiation if they were non-Hispanic or Asian and resided in urban areas. CONCLUSIONS: Most adolescents in our sample started HPV vaccination later than the recommended age, with variations in different demographic groups. Rapid improvement in on-time HPV vaccination is occurring, especially for males. CLINICAL RELEVANCE: The findings of this analysis emphasize continuous efforts to increase on-time HPV vaccination rates for all groups, including non-Hispanic whites and female adolescents, to eliminate current and possible disparities.

Effects of Physical Activity on Neurophysiological and Gene Expression Profiles in Chronic Back Pain: Study Protocol.

BACKGROUND: Despite the emphasis on exercise to reduce pain and improve function among people with chronic low back pain (cLBP), little is known about the underlying mechanism of the impact of exercise on the neurophysiological and gene transcription alterations that characterize cLBP. OBJECTIVES: To present a study protocol to examine the feasibility, acceptability, and initial efficacy of Problem-Solving Pain to Enhance Living Well (PROPEL) with the support of nurse consultations and wearable activity-tracking technology on self-management (SM) knowledge, skills, physical activity, and pain and to examine the differential neurophysiological and gene expression profiles in cLBP participants from pre- to post-PROPEL. METHODS: A pretest and posttest study is employed on 40 adults ages 18-60 years with cLBP who do not have serious complications and/or comorbidities that affect sensorimotor function. Participants will receive video modules focused on SM and biweekly phone consultations to facilitate symptom monitoring and problem-solving while increasing physical activity frequency and duration. Participants will be assessed for outcomes including SM skills, physical activity, and pain every 2 weeks for 12 weeks. We will examine the participants' differential neurophysiological and gene expression profiles at 12 weeks postintervention and correlate these outcomes with the total duration of physical activity. RESULTS: The study began in September 2018. Of the 99 subjects that were screened, 23 were enrolled and 8 completed data collection. DISCUSSION: Comparing the neurophysiological and gene expression profiles of people with cLBP exposed to PROPEL could inform the development of interventions that offer personalized physical activity dosage along with general SM support. Web-based programs such as PROPEL have the potential to enhance accessibility of evidence-based interventions that improve functionality and quality of life among people living with cLBP.

Familiarity, Navigation, and Comprehension: Key Dimensions of Health Literacy in Pap Test Use among Korean American Women.

Health literacy consists of multiple dimensions such as print and oral literacy or numeracy. Different dimensions of health literacy may have more salient impact on certain health behaviors and outcomes. Yet, evidence is limited regarding which dimensions particularly affect cervical cancer screening. The objective of this study was to examine the role of different dimensions of health literacy in cervical cancer screening among Korean American women. We used baseline data obtained from 560 Korean American women in a community-based health literacy-focused intervention study. Backward stepwise logistic regression analysis revealed that familiarity (adjusted odds ratio [AOR] = 1.20, 95% confidence interval [CI] = 1.11-1.31) and navigational health literacy (AOR = 1.10, 95% CI = 1.04-1.16) were associated with lifetime Pap test use and comprehension (AOR = 1.08, 95% CI = 1.02-1.14) with triennial Pap test screening. Prior exposure to healthcare settings and knowing how to navigate the healthcare system were more important than other health literacy dimensions for lifetime Pap test use. Understanding cancer screening-related words was most relevant to triennial Pap test use. In addition to addressing system factors such as insurance and physicians' recommendations, interventions to increase Pap test screening targeted at Korean American women are needed to address certain dimensions of health literacy such as familiarity, navigation, and comprehension.

Human Papillomavirus Vaccine Predictors Among U.S. Adults Aged 18 to 45 by Sexual Orientation.

Despite increased incidence rates of human papillomavirus (HPV)-associated cancers among sexual minorities, their HPV vaccine uptake remains suboptimal. This cross-sectional, correlational study aimed to investigate factors associated with HPV vaccination among a nationally representative sample of U.S. young adults by sexual orientation. We used the 2014 to 2017 Behavioral Risk Factor Surveillance System data for adults aged 18 to 45 years. HPV vaccination initiation was associated with being female and Hispanic, having higher educational attainment, and having ever been tested for HIV, whereas completion was associated with being female and non-Hispanic White and having higher educational attainment. Compared with those who reported identifying as straight, the lesbian or gay respondents were found to have been less likely not to complete the series. Providers should play a crucial part in addressing missed opportunities for HPV vaccination by implementing culturally competent communication strategies to empower sexual minorities to make informed HPV vaccine decisions.

The Association Between Health Literacy and Breast and Cervical Cancer Screening Behaviors: Findings From the Behavioral Risk Factor Surveillance System.

BACKGROUND: Health literacy has been linked to breast and cervical cancer screening, with inconsistent findings, which may result from the use of nonprobability sampling and a health literacy instrument that measures a subset of health literacy. OBJECTIVE: The aim of this study was to examine the association between health literacy and breast and cervical cancer screening using data from the Behavioral Risk Factor Surveillance System (BRFSS) that uses a nationally representative U.S. probability sample. METHODS: This cross-sectional, correlational study used national-level data from the 2016 BRFSS for women eligible for breast (N = 44,241) and cervical (N = 38,956) cancer screening per the American Cancer Society guidelines. A health literacy survey consisted of three items: oral (asking for medical advice), listening (understanding information that providers offer), and written (understanding printed health information) literacy. We extracted data regarding age, race/ethnicity, income, marital status, education, employment, insurance, and access to providers. Analyses were weighted using the complex survey design and multiple logistic regressions were used to test for the associations between health literacy and cancer screening after controlling for sociodemographic and healthcare system factors. RESULTS: Oral and listening literacies were contributing factors to up-to-date breast cancer screening (p = .002, p < .001, respectively). The association ceased to be significant in the presence of all three literacy items in one model. Oral and listening literacies were also associated with cervical cancer screening (p < .001, p = .005, respectively), but only oral literacy maintained significance in the presence of listening and written literacy items. DISCUSSION: Oral and listening literacies are contributing factors to lifetime breast cancer screening and up-to-date cervical cancer screening. Providers should create an atmosphere of effective patient-provider communication and informed decision-making by reducing health literacy demands in the medical encounter.