Mortality risk among adult americans living with cancer and elevated CRP.

The role of C Reactive Protein (CRP) in predicting long-term outcomes among people living with cancer has not been well explored. We aimed to assess the role of elevated CRP in predicting all-cause mortality among a community-based sample of adult Americans living with cancer. The National Health and Nutrition Examination Survey, 1999-2010 was linked with mortality files up to December 2019 from the National Death Index. Sociodemographic and health-related variables of 30,711 participants (mean age=46.5 years) were analyzed to compute adjusted hazard ratios (HR) for all-cause mortality. The risk of mortality, in unadjusted analysis, was significantly higher among those with cancer compared to those without cancer 3.53 (95% CI= 3.13-3.98, p < 0.001). In adjusted analysis, when stratified by CRP levels (elevated=cutoff point at ≥2 mg/dL), among individuals with elevated CRP but no cancer history, the risk of mortality was significantly higher (HR=1.67, 95% CI=1.24-2.25) compared to those without cancer or elevated CRP. Among individuals with cancer but without elevated CRP as well, the risk of mortality was 20% higher compared to their counterparts. The highest risk of mortality was observed among those with both cancer and elevated CRP (HR=2.10, 95% CI=1.11-4.33). Age and income were significant predictors of these relationships. Among people living with cancer, CRP may serve as a marker for mortality and future studies should explore the pathways by which the risk of mortality may increase due to variation of CRP in cancer patients.

Sweetened beverage consumption and risk of cardiovascular mortality: A systematic review and meta-analysis.

BACKGROUND AND AIMS: Several studies have reported the association of sweetened beverages (SB) with cardiovascular disease. However, the relationship between SB and cardiovascular mortality has not been clearly established. This systematic review and meta-analysis investigated the association between SB consumption and cardiovascular mortality. METHODS: PubMed/MEDLINE, Web of Science, and Embase were systematically searched up to July 31, 2021, for prospective cohort studies investigating this association in adults. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were used to assess the strength of association between SB: sugar-sweetened beverages (SSB)/artificial-sweetened beverages (ASB) exposure and cardiovascular mortality. RESULTS: A total of eight cohort studies comprising 1.2 million participants exposed to SB, reported 15,831 (1.2%) cases of cardiovascular mortality with a median follow-up of 12.2 years. Consuming at least one glass (250 ml) of SB per day (RR: 1.06; 95% CI: 1.00-1.12, P < 0.001) or ≥2 glasses per day (RR: 1.24; 95% CI: 1.16-1.31, P < 0.001) was significantly associated with increased risk of cardiovascular mortality. SSB and ASB intake of ≥2 glasses per day increased the risk of cardiovascular mortality by 21% (RR:1.21, 95% CI: 1.09-1.33, P < 0.001) and 33% (RR: 1.33, 95% CI: 1.12-1.55, P < 0.001), respectively. CONCLUSIONS: Our findings reveal that high SSB and ASB consumption are associated with an increased risk of cardiovascular mortality. Policymakers and public health practitioners should work on multisectoral strategies to reduce the consumption of sweetened beverages around the world and among all population groups.

Burden of Neurological Disorders Across the US From 1990-2017: A Global Burden of Disease Study.

Importance: Accurate and up-to-date estimates on incidence, prevalence, mortality, and disability-adjusted life-years (burden) of neurological disorders are the backbone of evidence-based health care planning and resource allocation for these disorders. It appears that no such estimates have been reported at the state level for the US. Objective: To present burden estimates of major neurological disorders in the US states by age and sex from 1990 to 2017. Design, Setting, and Participants: This is a systematic analysis of the Global Burden of Disease (GBD) 2017 study. Data on incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) of major neurological disorders were derived from the GBD 2017 study of the 48 contiguous US states, Alaska, and Hawaii. Fourteen major neurological disorders were analyzed: stroke, Alzheimer disease and other dementias, Parkinson disease, epilepsy, multiple sclerosis, motor neuron disease, migraine, tension-type headache, traumatic brain injury, spinal cord injuries, brain and other nervous system cancers, meningitis, encephalitis, and tetanus. Exposures: Any of the 14 listed neurological diseases. Main Outcome and Measure: Absolute numbers in detail by age and sex and age-standardized rates (with 95% uncertainty intervals) were calculated. Results: The 3 most burdensome neurological disorders in the US in terms of absolute number of DALYs were stroke (3.58 [95% uncertainty interval [UI], 3.25-3.92] million DALYs), Alzheimer disease and other dementias (2.55 [95% UI, 2.43-2.68] million DALYs), and migraine (2.40 [95% UI, 1.53-3.44] million DALYs). The burden of almost all neurological disorders (in terms of absolute number of incident, prevalent, and fatal cases, as well as DALYs) increased from 1990 to 2017, largely because of the aging of the population. Exceptions for this trend included traumatic brain injury incidence (-29.1% [95% UI, -32.4% to -25.8%]); spinal cord injury prevalence (-38.5% [95% UI, -43.1% to -34.0%]); meningitis prevalence (-44.8% [95% UI, -47.3% to -42.3%]), deaths (-64.4% [95% UI, -67.7% to -50.3%]), and DALYs (-66.9% [95% UI, -70.1% to -55.9%]); and encephalitis DALYs (-25.8% [95% UI, -30.7% to -5.8%]). The different metrics of age-standardized rates varied between the US states from a 1.2-fold difference for tension-type headache to 7.5-fold for tetanus; southeastern states and Arkansas had a relatively higher burden for stroke, while northern states had a relatively higher burden of multiple sclerosis and eastern states had higher rates of Parkinson disease, idiopathic epilepsy, migraine and tension-type headache, and meningitis, encephalitis, and tetanus. Conclusions and Relevance: There is a large and increasing burden of noncommunicable neurological disorders in the US, with up to a 5-fold variation in the burden of and trends in particular neurological disorders across the US states. The information reported in this article can be used by health care professionals and policy makers at the national and state levels to advance their health care planning and resource allocation to prevent and reduce the burden of neurological disorders.

Adolescent Body Weight Perception: Association With Diet and Physical Activity Behaviors.

To assess the prevalence of weight misperception in American adolescents and its association with diet and physical activity behaviors, Youth Risk Behavior Survey data were utilized for this study. Based on reported and perceived weight, adolescents in the study were grouped into four categories (true negative [52.4%] = normal body mass index [BMI]/accurate weight perception; false negative [11.3%] = high BMI/weight misperception; false positive [11.6%] = normal BMI/weight misperception; and true positive [24.8%] = high BMI/accurate weight perception). Diet and physical activity of adolescents were compared in these categories. A total of 12,016 participants were included in our analysis (74.9% aged 15-17 years, 54.5% Whites, 52% females). Almost a third (31.8%) were overweight and obese, and more than a fifth (22.9%) misperceived their weight (11.6% overestimated and 11.3% underestimated their weight). In a gender-stratified analysis, the odds of avoiding a healthy diet and physical inactivity were higher among those with body weight misperception.

Epidemiology of falls and fall-related injuries among middle-aged adults with kidney disease.

PURPOSE: Comorbidities, such as kidney disease (CKD), increase the likelihood of falls and fall-related injuries. Despite the focus of most research in this population on older adults, falls are a significant cause of injury throughout adulthood. Therefore, we aimed to describe the epidemiology of falls in middle-aged adults with kidney diseases. METHODS: We analyzed falls and fall-related injuries among middle-aged adults (45-65 years old) with and without CKD included in the 2014 Behavioral Risk Factor Surveillance System (BRFSS) utilizing multivariate logistic regression and complex sample survey data analysis procedures. RESULTS: Middle-aged adults with CKD were more likely to suffer a fall (2.30, 95% CI 2.07-2.55) and a fall-related injury (1.54, 95% CI 1.32-1.80) compared to those without CKD. However, only the increased likelihood for falls remained significant after correction for multiple demographic, health, lifestyle, and comorbid conditions (AOR 1.22, 95% CI 1.08-1.39). Among adults with CKD, general health status, smoking, and total comorbidity scores were significant predictors of falls and fall-related injuries (p < 0.05 for all). Furthermore, individual comorbidities such as COPD, asthma, depressive disorders, stroke, and arthritis also predicted falls and fall-related injuries (p < 0.05 for all). CONCLUSION: Middle-aged adults with CKD were more likely than those without CKD to fall and suffer a fall-related injury. However, injury risk did not remain elevated after accounting for differences between groups. The presence of comorbidities, especially depressive disorders, was associated with increased odds for falls and fall-related injuries. Given the high prevalence of depression among adults with CKD, the relationship between depression and falls warrants further examination.

Smoking cessation education and training in obstetrics and gynecology residency programs in the United States.

BACKGROUND: OB/GYN physicians should be involved in providing smoking cessation counseling to their patients who smoke, especially pregnant patients. However, the smoking cessation practices of OB/GYN physicians seem to be dependent on their education and training and not much is known about their training during medical school. Therefore, the purpose of this study was to assess the smoking cessation education provided by OB/GYN residency training programs in the United States. METHODS: The investigators developed and mailed a valid and reliable survey to all allopathic and osteopathic OB/GYN Residency Directors in the US (n = 275). The internal reliability coefficients (Cronbach alpha) for the four major subscales ranged from 0.63 to 0.90. Best practices in survey research were used to achieve a final response rate of 58%. RESULTS: The majority of residency programs (60%) did not have a formal, structured curriculum in tobacco topics and/or smoking cessation. In contrast, 40% of programs reported having a formal, structured tobacco education curriculum. Sixty-five percent of programs did not formally evaluate residents' competence in providing smoking cessation counseling to patients. A range of 42% to 57% of residency programs reported spending less than one hour/year on teaching various basic science and clinical science topics related to tobacco use. The majority of residency programs spent no time teaching residents about the socio-political aspects of tobacco use cessation. Lack of teaching time was identified by the majority (51%) of the residency directors as a barrier to teaching smoking cessation. CONCLUSION: Although OB/GYN physicians are expected to provide smoking cessation counseling to their patients, the majority of OB/GYN residency programs in the United States provide minimal education and training in this area. Therefore, continuing medical education on smoking cessation counseling should be broadly implemented for OB/GYN physicians.

The Burden of Cardiovascular Diseases Among US States, 1990-2016.

Importance: Cardiovascular disease (CVD) is the leading cause of death in the United States, but regional variation within the United States is large. Comparable and consistent state-level measures of total CVD burden and risk factors have not been produced previously. Objective: To quantify and describe levels and trends of lost health due to CVD within the United States from 1990 to 2016 as well as risk factors driving these changes. Design, Setting, and Participants: Using the Global Burden of Disease methodology, cardiovascular disease mortality, nonfatal health outcomes, and associated risk factors were analyzed by age group, sex, and year from 1990 to 2016 for all residents in the United States using standardized approaches for data processing and statistical modeling. Burden of disease was estimated for 10 groupings of CVD, and comparative risk analysis was performed. Data were analyzed from August 2016 to July 2017. Exposures: Residing in the United States. Main Outcomes and Measures: Cardiovascular disease disability-adjusted life-years (DALYs). Results: Between 1990 and 2016, age-standardized CVD DALYs for all states decreased. Several states had large rises in their relative rank ordering for total CVD DALYs among states, including Arkansas, Oklahoma, Alabama, Kentucky, Missouri, Indiana, Kansas, Alaska, and Iowa. The rate of decline varied widely across states, and CVD burden increased for a small number of states in the most recent years. Cardiovascular disease DALYs remained twice as large among men compared with women. Ischemic heart disease was the leading cause of CVD DALYs in all states, but the second most common varied by state. Trends were driven by 12 groups of risk factors, with the largest attributable CVD burden due to dietary risk exposures followed by high systolic blood pressure, high body mass index, high total cholesterol level, high fasting plasma glucose level, tobacco smoking, and low levels of physical activity. Increases in risk-deleted CVD DALY rates between 2006 and 2016 in 16 states suggest additional unmeasured risks beyond these traditional factors. Conclusions and Relevance: Large disparities in total burden of CVD persist between US states despite marked improvements in CVD burden. Differences in CVD burden are largely attributable to modifiable risk exposures.

Violent Behaviors, Weapon Carrying, and Firearm Homicide Trends in African American Adolescents, 2001-2015.

African American youths have the highest risk for firearm and other weapon related homicides. This study utilized the national Youth Risk Behavior Surveys from 2001 to 2015 to assess trends in violence related behaviors and weapon carrying of African American adolescents. Our analyses found statistically significant reductions in physical fighting and weapon carrying among African American male adolescents from 2007 to 2015. Planning suicide increased in both male and female African American adolescents since 2007. In addition, the number of firearm homicides increased in African American males. African American females and males had groups of items highly predictive of weapon carrying behaviors: alcohol, tobacco, and other drug use and violent risk behaviors. Both female and male students who made mostly A's or B's in school were significantly less likely to carry weapons in and out of school. Our findings indicate that firearm homicides have increased in African American adolescents, but weapon carrying in school going adolescents has significantly declined. School engagement and satisfactory school performance seems to have a significant protective effect on firearm homicides and violent behavior risks in African American adolescents.

Violence Related Behaviors and Weapon Carrying Among Hispanic Adolescents: Results from the National Youth Risk Behavior Survey, 2001-2015.

Hispanic youths are disproportionately represented in gangs in the United States, are more likely to drink alcohol at younger ages, and to live in poverty; all are risks for violence and weapon carrying. No studies to date have assessed violence related behaviors and weapon carrying in Hispanic youth over an extended period. This study utilized the national Youth Risk Behavior Surveys from 2001 to 2015 to assess trends in violence related behaviors and weapon carrying of Hispanic adolescents. Our analyses found both physical fighting and fighting on school property had statistically significant reductions from 2001 to 2015 for Hispanic females and their suicide attempts increased from 2009 to 2015. Hispanic males had statistically significant decreasing trends for: being in a physical fight in the past year, being bullied on school property, being in a physical fight on school property within the past year; threatened or injured with a weapon on school property in the past year; and having attempted suicide in the past year. Hispanic females and males had two groups of items highly predictive of weapon carrying behaviors: alcohol, tobacco, and other drug use and violent risk behaviors. Both female and male students who made mostly A's or B's in school were significantly less likely (about half as likely) to carry weapons. This data could be used to identify Hispanic adolescents at higher risk for weapon carrying and used as a basis for enriching programs to improve academic success of Hispanic adolescents.

Burden of Skin and Subcutaneous Diseases in Iran and Neighboring Countries: Results from the Global Burden of Disease Study 2015.

BACKGROUND: Iran and its neighboring countries represent four world regions with unique cultures and geography. Skin diseases span a wide diversity of etiologies including infectious, inflammatory, autoimmune, vascular, neurogenic, and oncologic. The Global Burden of Disease Study (GBD) 2015 measures the burden from skin diseases in 195 countries. METHODS: Epidemiologic data were collected from literature review, survey data, and hospital inpatient/outpatient claims data. These raw data entered modeling using a Bayesian meta-regression tool, DisMod MR-2.1, which yielded prevalence estimates by age/sex/location/year. Prevalence estimates were combined with disability weights to yield years lived with disability (YLDs). YLDs are combined with years of life lost (YLLs), from mortality estimates, to yield disability-adjusted life years (DALYs). DALYs were obtained for 16 skin conditions and both sexes in Iran and 15 surrounding countries. The sociodemographic index (SDI) for each country was also correlated with skin disease DALY rate using the Pearson coefficient (r) with two-tailed P-value. RESULTS: There was no significant correlation between individual skin diseases and SDI. Acne and dermatitis caused the greatest burden and BCC the lowest burden of skin diseases in Iran and the other 15 countries. SCC and BCC were responsible for the largest discrepancy by sex, with higher burden in males compared to females. CONCLUSION: Skin diseases, particularly dermatitis and acne, cause considerable burden in Iran and surrounding regions. Objective and transparent epidemiologic data such as GBD has the potential to inform and impact many facets of healthcare, research prioritization, public policy, and international partnerships.

Tobacco use related attitudes and behaviors in Indian Adolescents: association with school-based prevention education.

Background: Adolescent tobacco use in India has increased substantially within the past few decades. Schools can serve as an important avenue for prevention education, but little is known about the current practices of Indian schools in relation to tobacco use prevention education. Methods: To assess the extent and influence tobacco use prevention education in Indian schools,we analyzed the Global Youth Tobacco Survey data for India, which was a population-based study of a national random sample of 10112 students from 180 private and public schools.Variables such as student demographic profile, tobacco use behavior, perceptions about tobacco use, and exposure to school-based tobacco use prevention education were considered for analyses. Results: Prevalence of any form of tobacco use (14%) and current smoking (8%) was found to differ by gender. A quarter of the students believed that boys who smoke are more attractive or have more friends compared to non-smokers, and almost half of the students reported that smoking and health were never discussed as a part of a lesson in school. The association between school-based prevention education and tobacco use behavior was assessed (after adjustment forage, gender, and parental smoking). Students who were educated in school about tobacco use and its effects were significantly more likely to have negative attitude toward tobacco use and less likely to report use of tobacco. Conclusion: School-based tobacco use prevention education has beneficial influence on adolescents in India. Given the early age of initiation of tobacco use, school curricula in India should emphasize on tobacco use prevention education.

Applying a new theory to smoking cessation: case of multi-theory model (MTM) for health behavior change.

Background: Smoking continues to be a public health problem worldwide. Smoking and tobacco use are associated with cardiovascular diseases that include coronary heart disease, atherosclerosis, cerebrovascular disease, and abdominal aortic aneurysm. Programs for quitting smoking have played a significant role in reduction of smoking in the United States. The smoking cessation interventions include counseling, nicotine replacement therapy, buproprion therapy, and varenicline therapy. The success rates with each of these approaches vary with clear need for improvement. Moreover, there is a need for a robust theory that can guide smoking cessation counseling interventions and increase the success rates. A fourth generation approach using multi-theory model (MTM) of health behavior change is introduced in this article for smoking cessation. An approach for developing and evaluating an intervention for smoking cessation is presented along with a measurement tool. Methods: A literature review reifying the MTM of health behavior change for smoking cessation has been presented. An instrument designed to measure constructs of MTM and associated smoking cessation behavior has been developed. Results: The instrument developed is available for validation, reliability and prediction study pertaining to smoking cessation. The intervention is available for testing in a randomized control trial involving smokers. Conclusion: MTM is a robust theory that holds promise for testing and application to smoking cessation.

Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-years for 32 Cancer Groups, 1990 to 2015: A Systematic Analysis for the Global Burden of Disease Study.

IMPORTANCE: Cancer is the second leading cause of death worldwide. Current estimates on the burden of cancer are needed for cancer control planning. OBJECTIVE: To estimate mortality, incidence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 32 cancers in 195 countries and territories from 1990 to 2015. EVIDENCE REVIEW: Cancer mortality was estimated using vital registration system data, cancer registry incidence data (transformed to mortality estimates using separately estimated mortality to incidence [MI] ratios), and verbal autopsy data. Cancer incidence was calculated by dividing mortality estimates through the modeled MI ratios. To calculate cancer prevalence, MI ratios were used to model survival. To calculate YLDs, prevalence estimates were multiplied by disability weights. The YLLs were estimated by multiplying age-specific cancer deaths by the reference life expectancy. DALYs were estimated as the sum of YLDs and YLLs. A sociodemographic index (SDI) was created for each location based on income per capita, educational attainment, and fertility. Countries were categorized by SDI quintiles to summarize results. FINDINGS: In 2015, there were 17.5 million cancer cases worldwide and 8.7 million deaths. Between 2005 and 2015, cancer cases increased by 33%, with population aging contributing 16%, population growth 13%, and changes in age-specific rates contributing 4%. For men, the most common cancer globally was prostate cancer (1.6 million cases). Tracheal, bronchus, and lung cancer was the leading cause of cancer deaths and DALYs in men (1.2 million deaths and 25.9 million DALYs). For women, the most common cancer was breast cancer (2.4 million cases). Breast cancer was also the leading cause of cancer deaths and DALYs for women (523 000 deaths and 15.1 million DALYs). Overall, cancer caused 208.3 million DALYs worldwide in 2015 for both sexes combined. Between 2005 and 2015, age-standardized incidence rates for all cancers combined increased in 174 of 195 countries or territories. Age-standardized death rates (ASDRs) for all cancers combined decreased within that timeframe in 140 of 195 countries or territories. Countries with an increase in the ASDR due to all cancers were largely located on the African continent. Of all cancers, deaths between 2005 and 2015 decreased significantly for Hodgkin lymphoma (-6.1% [95% uncertainty interval (UI), -10.6% to -1.3%]). The number of deaths also decreased for esophageal cancer, stomach cancer, and chronic myeloid leukemia, although these results were not statistically significant. CONCLUSION AND RELEVANCE: As part of the epidemiological transition, cancer incidence is expected to increase in the future, further straining limited health care resources. Appropriate allocation of resources for cancer prevention, early diagnosis, and curative and palliative care requires detailed knowledge of the local burden of cancer. The GBD 2015 study results demonstrate that progress is possible in the war against cancer. However, the major findings also highlight an unmet need for cancer prevention efforts, including tobacco control, vaccination, and the promotion of physical activity and a healthy diet.

Association of Job Insecurity with Health Risk Factors and Poorer Health in American Workers.

Perceived job insecurity and health risk factors have not been well studied in the United States (US) workforce. The purpose of this study was to assess the association of specific health risk factors and morbidities with perceived job insecurity in a large national random sample of working adults in the US. The National Health Interview Survey data were analyzed for this study. We computed the prevalence of perceived job insecurity by demographic characteristics and tested the relative association between perceived job insecurity and selected health risk factors using logistic regression analysis with adjusted odds ratios (AORs). A total of 17,441 working adults were included in the study: 75 % Whites, 51.5 % females, 73.3 % worked for a private company, and 82.6 % were 25-64 years of age. One in three (33 %) workers perceived their job to be insecure. Those who reported job insecurity had significantly higher odds of: being obese, sleeping less than 6 h/day, smoking every day, having work loss days >2 weeks, and worsening of general health in the past year. Job insecure individuals had a likelihood of serious mental illness within the past 30 days almost five times higher than those who were not job insecure. In addition, job insecure individuals were significantly more likely to report pain conditions (i.e. headaches, neck pain, and low back pain), and lifetime histories of having ulcers, diabetes, hypertension, angina pectoris, and coronary heart diseases. Job insecurity is associated with poor health and health risk behaviors in American adults. Potential interventions to address job insecurity and improve the health and well-being of working adults have been discussed based on study findings.

The Psychometric Properties of PHQ-4 Depression and Anxiety Screening Scale Among College Students.

Depression and anxiety are some of the most common causes of morbidity, social dysfunction, and reduced academic performance in college students. The combination of improved surveillance and access to care would result in better outreach. Brief screening tools can help reach larger populations of college students efficiently. However, reliability and validity of brief screeners for anxiety and depression have not been assessed in college students. Thus, the purpose of this study was to assess in a sample of college students the psychometric properties of PHQ-4, a brief screening tool for depression and anxiety. Undergraduate students were recruited from general education classes at a Midwestern university. Students were given a questionnaire that asked them whether they had been diagnosed by a doctor or health professional with anxiety or depression. Next, they were asked to respond to the items on the PHQ-4 scale. A total of 934 students responded to the survey (response rate=72%). Majority of the participants were females (63%) and Whites (80%). The internal reliability of PHQ-4 was found to be high (α=0.81). Those who were diagnosed with depression or anxiety had statistically significantly higher scores on PHQ-4 (p<0.01). Corrected item total correlations for PHQ-4 were between r=0.66 and r=0.80. PHQ-4 operating characteristics were estimated and area under the curve (AUC) values were 0.835 and 0.787, respectively for anxiety and depression. The PHQ-4 is a reliable and valid tool that can serve as a mass screener for depression and anxiety in young adults. Widespread implementation of this screening tool should be explored across college campuses.

Reducing Premature Mortality in the Mentally Ill Through Health Promotion Programs.

Nearly half of the U.S. adult population will have a major mental illness during their lifetimes. At any point in time, almost a fifth of all American adults have a serious mental illness (SMI). Too many in our society do not understand mental illnesses, placing the blame for the illness on those with the illness, resulting in isolation, marginalization, or incarceration of individuals with SMIs. They may experience stigma, inadequate and delayed health and mental health care, and major socioeconomic disadvantages. They may struggle with activities of daily living, lose many of their resources, and spiral down into poverty. The disadvantages and decreased ability to function experienced by individuals with SMIs lead to increased unhealthy behaviors, reduced participation in wellness-related activities, and premature morbidity and mortality. The general and physical health of individuals with SMIs poses greater challenges from both practice and research standpoints. However, health educators are poised uniquely to provide health promotion programs, conduct research, and advocate for the health and well-being of individuals with SMIs. In this review, we summarize the challenges and opportunities for health promotion in individuals with SMIs.

Effectiveness of a Brief Psychosocial Intervention on Quality of Life of Primary Caregivers of Iranian Children With Cancer: A Randomized Controlled Trial.

UNLABELLED: Cancer in children has a great impact on primary caregiver quality of life (QOL). OBJECTIVE: This study examined the effectiveness of a brief psychosocial intervention (BPI) on QOL of Primary Caregivers of Children with Cancer (PCCCs). METHODS: Sixty-five PCCCs participated in a randomized controlled trial in Mahak Hospital and Rehabilitation Complex in Tehran, Iran. A 5-week long BPI (which comprised of counseling sessions and telephone follow-up) was delivered to the intervention group in addition to usual service, while the control group was provided with usual service. Data were collected using the Caregiver Quality of Life Index-Cancer-Persian version (CQOLC-P) prior to intervention, post-intervention, and at follow-up (i.e. 30days after the intervention). Repeated measures analysis of variance analysis (ANOVA) was used to evaluate outcomes. RESULTS: Majority of the participants were mothers (95%), between ages of 24-47 years (95%) with children between ages of 2-12 years. Most child cancer diagnoses were for brain tumors (n=31) and blood cancers (n=17). Significant improvement was found within the intervention group on QOL (p<0.001) including improvements on subscale measures of mental/emotional burden (p<0.001), disruption (p<0.001), and positive adaptation (p<0.001), compared with the control group over time. There was no difference between the intervention and control groups on the financial subscale measure after intervention (p>0.05). CONCLUSION: BPI was an effective strategy to improve the quality of life of PCCCs. Similar interventions can be planned by practitioners to reduce the burden of childhood cancer on PCCCs.

Racial/ethnic disparities in chronic diseases of youths and access to health care in the United States.

Racial/ethnic minorities are 1.5 to 2.0 times more likely than whites to have most of the major chronic diseases. Chronic diseases are also more common in the poor than the nonpoor and this association is frequently mediated by race/ethnicity. Specifically, children are disproportionately affected by racial/ethnic health disparities. Between 1960 and 2005 the percentage of children with a chronic disease in the United States almost quadrupled with racial/ethnic minority youth having higher likelihood for these diseases. The most common major chronic diseases of youth in the United States are asthma, diabetes mellitus, obesity, hypertension, dental disease, attention-deficit/hyperactivity disorder, mental illness, cancers, sickle-cell anemia, cystic fibrosis, and a variety of genetic and other birth defects. This review will focus on the psychosocial rather than biological factors that play important roles in the etiology and subsequent solutions to these health disparities because they should be avoidable and they are inherently unjust. Finally, this review examines access to health services by focusing on health insurance and dental insurance coverage and access to school health services.

Indian students' perspectives on obesity and school-based obesity prevention: a qualitative examination.

Childhood obesity has recently been reported as a growing problem in low- and middle-income countries. One potential prevention strategy is to apply effective obesity prevention approaches from the United States and/or other Western countries into programs that can be implemented in developing countries such as India. The purpose of this study was to explore Indian students' perceptions of social-contextual factors related to obesity and whether they perceived a role for school-based obesity prevention. This study was conducted as a first step in a model to translate interventions from one culture to another. A total of 183 fourth- and fifth-grade students of middle socioeconomic status participated in focus group discussions. Analyses were guided by the essential principles of qualitative research and informed by social cognitive and social ecological theories. Results yielded five relevant themes: (a) student health behavior knowledge, (b) parental influence on health behavior, (c) school influence on health behavior, (d) media influence on health behavior, and (e) contexts for health promotion intervention. We found that students had moderate knowledge related to health behaviors (i.e., food intake and physical activity); that parents, schools, and the media are all important contributors to healthy and unhealthy behavior; and that schools can play an important role in the prevention of obesity. Results suggest that Indian middle socioeconomic status students are already moderately aware of the health benefits to nutritious food intake and physical activity, but parents, schools, and the media can influence unhealthy behaviors.

Do respiratory therapists receive training and education in smoking cessation? A national study of post-secondary training programs.

OBJECTIVE: To assess the tobacco-related education provided by post-secondary respiratory therapy training programs in the United States. METHODS: A cross-sectional research design was used to survey the entire population of program directors of post-secondary, respiratory therapy training programs in the United States. A valid and reliable questionnaire was developed and mailed using a 2-wave mailing technique (73% return rate). Internal reliability coefficients (Cronbach alpha) for the various components of the questionnaire ranged from 0.78 to 0.91. RESULTS: More than half of programs (56%) offered no teaching on the 5R's. Nearly half (47%) offered no teaching on the 5A's. Of the 13 tobacco-related topics listed in the basic science and clinical science sections of the questionnaire, only one topic (i.e., diseases linked to tobacco use) received 3h or more of instruction by approximately a third of programs (35.8%). The majority of programs (>90%) spent no time teaching students about the socio-political aspects of tobacco use cessation. Moreover, 41% of programs did not formally evaluate students' competence in providing smoking cessation counseling to patients. CONCLUSIONS: Tobacco-related education is a very minor component of the education and training received by respiratory therapy students in the United States. PRACTICE IMPLICATIONS: Respiratory therapy training programs in the United States have great potential to strengthen the tobacco-related education that they provide to students. Practicing respiratory therapists would likely benefit from continuing medical education focused on how to use evidence-based smoking cessation counseling techniques with patients.