Variation in Reporting of the Race and Ethnicity of COVID-19 Cases and Deaths Across US States: April 12, 2020, and November 9, 2020.

Despite growing evidence that COVID-19 is disproportionately affecting communities of color, state-reported racial/ethnic data are insufficient to measure the true impact.We found that between April 12, 2020, and November 9, 2020, the number of US states reporting COVID-19 confirmed cases by race and ethnicity increased from 25 to 50 and 15 to 46, respectively. However, the percentage of confirmed cases reported with missing race remained high at both time points (29% on April 12; 23% on November 9). Our analysis demonstrates improvements in reporting race/ethnicity related to COVID-19 cases and deaths and highlights significant problems with the quality and contextualization of the data being reported.We discuss challenges for improving race/ethnicity data collection and reporting, along with opportunities to advance health equity through more robust data collection and contextualization. To mitigate the impact of COVID-19 on racial/ethnic minorities, accurate and high-quality demographic data are needed and should be analyzed in the context of the social and political determinants of health.

Percentage of Black Population and Primary Care Shortage Areas Associated with Higher COVID-19 Case and Death Rates in Georgia Counties.

OBJECTIVES: We hypothesized that the proportion of Black individuals in a county would be associated with higher rates of coronavirus disease 2019 (COVID-19) cases and deaths, even after accounting for other high-risk socioecologic factors such as poverty, population density, and household crowding, and uninsured rates. We also expected that counties designated as primary care health professional shortage areas (PCHPSAs) would be associated with higher COVID-19 death rates, and the lack of primary care access would exacerbate racial disparities in death rates. We undertook this study to test these hypotheses and discern the independent effects of racial composition, socioecologic characteristics, and healthcare system factors on COVID-19 cases and deaths in Georgia counties. METHODS: We used county-level COVID-19 cases and deaths on April 23, 2020 from the Johns Hopkins Coronavirus Resource Center and estimates of 2019 county-level populations from the US Census Bureau to calculate the cumulative event rates for the state of Georgia. We used multiple regression models to examine crude and adjusted associations of socioecologic and health system variables with county-level COVID-19 case and mortality rates. RESULTS: After adjustment, a 1% increase in the proportion of Black people in the county resulted in a 2.3% increase in the county COVID-19 confirmed case rate and a 3.0% increase in the death rate (relative risk 1.03, 95% confidence interval 1.01-1.05, P < 0.001). Primary care shortage areas had a 74% higher death rate (relative risk 1.74, 95% confidence interval 1.00-3.00, P = 0.049). CONCLUSIONS: These results highlight the impact of racial disparities on the spatial patterns of COVID-19 disease burden in Georgia, which can guide interventions to mitigate racial disparities. The results also support the need for robust primary care infrastructure throughout the state.

Population-Level Disparities in COVID-19: Measuring the Independent Association of the Proportion of Black Population on COVID-19 Cases and Deaths in US Counties.

CONTEXT: There is a need to understand population race and ethnicity disparities in the context of sociodemographic risk factors in the US experience of the COVID-19 pandemic. OBJECTIVE: Determine the association between county-level proportion of non-Hispanic Black (NHB) on county COVID-19 case and death rates and observe how this association was influenced by county sociodemographic and health care infrastructure characteristics. DESIGN AND SETTING: This was an ecologic analysis of US counties as of September 20, 2020, that employed stepwise construction of linear and negative binomial regression models. The primary independent variable was the proportion of NHB population in the county. Covariates included county demographic composition, proportion uninsured, proportion living in crowded households, proportion living in poverty, population density, state testing rate, Primary Care Health Professional Shortage Area status, and hospital beds per 1000 population. MAIN OUTCOME MEASURES: Outcomes were exponentiated COVID-19 cases per 100 000 population and COVID-19 deaths per 100 000 population. We produced county-level maps of the measures of interest. RESULTS: In total, 3044 of 3142 US counties were included. Bivariate relationships between the proportion of NHB in a county and county COVID-19 case (Exp ß = 1.026; 95% confidence interval [CI], 1.024-1.028; P < .001) and death rates (rate ratio [RR] = 1.032; 95% CI, 1.029-1.035; P < .001) were not attenuated in fully adjusted models. The adjusted association between the proportion of NHB population in a county and county COVID-19 case was Exp ß = 1.025 (95% CI, 1.023-1.027; P < .001) and the association with county death rates was RR = 1.034 (95% CI, 1.031-1.038; P < .001). CONCLUSIONS: The proportion of NHB people in a county was positively associated with county COVID-19 case and death rates and did not change in models that accounted for other socioecologic and health care infrastructure characteristics that have been hypothesized to account for the disproportionate impact of COVID-19 on racial and ethnic minority populations. Results can inform efforts to mitigate the impact of structural racism of COVID-19.

Predictors of genetic beliefs toward cancer risk perceptions among adults in the United States: Implications for prevention or early detection.

The objective of this study is to assess predictors of genetic beliefs toward cancer risk perceptions among adults, aged 18 years and over, in the United States (US). Data were obtained from the National Cancer Institute's (NCI) Health Information National Trends Survey 2014 (HINTS) 4 Cycle 4. Bivariate and multivariable logistic regression analyses were conducted to assess factors associated with an individual's beliefs about genetic and cancer risk perceptions. The results showed that African Americans, Non-White Hispanics, Non-Hispanic Asians, individuals with a high school education or less, and annual household incomes less than $20,000 and do not believe that health behaviors play some role in determining whether a person will develop cancer was significantly less likely to report that genetics plays at least some role in whether a person will develop cancer. Findings of this study provide an opportunity for genetic counselors to address beliefs about genetics and cancer risk perceptions among minority populations and promote health equity.

Home-based physical activity interventions for breast cancer patients receiving primary therapy: a systematic review.

PURPOSE: Breast cancer continues to be the leading cause of cancer in women in the US, so it is important to provide these women with good therapies. However, there are adverse effects to these therapies. Physical activity plays an important role in alleviating these adverse effects of breast cancer therapy. However, the effectiveness of home-based physical activity interventions such as walking programs has not been detailed by prior reviews. METHODS: This article reviews articles published to date to examine whether home-based physical activity interventions are effective in improving physical activity and other outcomes among breast cancer patients who are undergoing primary therapy for the disease. The present review is based upon bibliographic searches in PubMed and CINAHL and relevant search terms. Articles published in English from 1980 through February 28, 2019 were identified. A total of 360 article citations were identified in PubMed and non-duplicates in CINAHL. RESULTS: After screening the abstracts or full texts of these articles and reviewing the references of previous review articles, we found 15 studies that met the eligibility criteria. Four of the studies were pre/post-test trials, 10 were randomized controlled trials, and one study was an observational study. CONCLUSION: Results from studies published to date indicate that among women receiving primary breast cancer therapy, home-based physical activity programs have positive effects on physical functioning and symptoms such as fatigue. Among women receiving adjuvant chemotherapy or radiation therapy, home-based physical activity programs are effective in reducing symptoms and improving physical functioning. Additional studies are needed to clarify the impact of home-based physical therapy interventions on other outcomes including quality-of-life, bone mineral density, cognitive functioning, and chemotherapy-induced peripheral neuropathy.

The Role of Mock Reviewing Sessions in the National Research Mentoring Network Strategic Empowerment Tailored for Health Equity Investigators: A Randomized Controlled Study.

The National Research Mentoring Network (NRMN) Strategic Empowerment Tailored for Health Equity Investigators (SETH) study evaluates the value of adding Developmental Network to Coaching in the career advancement of diverse Early-Stage Investigators (ESIs). Focused NIH-formatted Mock Reviewing Sessions (MRS) prior to the submission of grants can significantly enhance the scientific merits of an ESI's grant application. We evaluated the most prevalent design, analysis-related factors, and the likelihood of grant submissions and awards associated with going through MRS, using descriptive statistics, Chi-square, and logistic regression methods. A total of 62 out of 234 applications went through the MRS. There were 69.4% that pursued R grants, 22.6% career development (K) awards, and 8.0% other grant mechanisms. Comparing applications that underwent MRS versus those that did not (N = 172), 67.7% vs. 38.4% were submitted for funding (i.e., unadjusted difference of 29.3%; OR = 4.8, 95% CI = (2.4, 9.8), p-value < 0.0001). This indicates that, relative to those who did not undergo MRS, ESIs who did, were 4.8 times as likely to submit an application for funding. Also, ESIs in earlier cohorts (1-2) (a period that coincided with the pre COVID-19 era) as compared to those who were recruited at later cohorts (3-4) (i.e., during the peak of COVID-19 period) were 3.8 times as likely to submit grants (p-value < 0.0001). The most prevalent issues that were identified included insufficient statistical design considerations and plans (75%), conceptual framework (28.3%), specific aims (11.7%), evidence of significance (3.3%), and innovation (3.3%). MRS potentially enhances grant submissions for extramural funding and offers constructive feedback allowing for modifications that enhance the scientific merits of research grants.

Individual and Institutional Factors Contribute to Research Capacity Building for Early-Stage Investigators from Groups Underrepresented in Biomedical Research: A Qualitative Comparative Analysis.

BACKGROUND: Enhancement of diversity within the U.S. research workforce is a recognized need and priority at a national level. Existing comprehensive programs, such as the National Research Mentoring Network (NRMN) and Research Centers in Minority Institutions (RCMI), have the dual focus of building institutional research capacity and promoting investigator self-efficacy through mentoring and training. METHODS: A qualitative comparative analysis was used to identify the combination of factors that explain the success and failure to submit a grant proposal by investigators underrepresented in biomedical research from the RCMI and non-RCMI institutions. The records of 211 participants enrolled in the NRMN Strategic Empowerment Tailored for Health Equity Investigators (NRMN-SETH) program were reviewed, and data for 79 early-stage, underrepresented faculty investigators from RCMI (n = 23) and non-RCMI (n = 56) institutions were included. RESULTS: Institutional membership (RCMI vs. non-RCMI) was used as a possible predictive factor and emerged as a contributing factor for all of the analyses. Access to local mentors was predictive of a successful grant submission for RCMI investigators, while underrepresented investigators at non-RCMI institutions who succeeded with submitting grants still lacked access to local mentors. CONCLUSION: Institutional contexts contribute to the grant writing experiences of investigators underrepresented in biomedical research.

Impact of COVID-19 on the Research Career Advancement of Health Equity Scholars from Diverse Backgrounds.

The COVID-19 pandemic has significantly taxed scientific research and seems to have exacerbated existing inequities within the research field, particularly for early-stage investigators (ESIs). This study examines the effects of the COVID-19 pandemic on traditionally underrepresented ESIs enrolled in an NIH-supported study evaluating the effectiveness of developmental networks, grant writing coaching, and mentoring on research career advancement. The survey consisted of 24 closed-ended (quantitative) and 4 open-ended questions (qualitative) linked to a participant's ability to meet grant submission deadlines, research and professional development disruptions, stress level, career transition level, self-efficacy and management of scholarly tasks, and familial responsibilities. Results from 32 respondents (53%) suggest that COVID-19 adversely impacted the continuity of research (81%) and grant submissions (63%). On average, grant submissions were delayed by 6.69 months (i.e., greater than one grant cycle). We also conducted additional analyses characterizing nonresponse and found that there were no significant predictors of nonresponse, indicating a limited threat to the validity of our findings. The disruption caused by COVID-19 to the careers of ESIs from underrepresented groups in the biomedical workforce has been profound in the short term. The long-term consequences to the future success of these groups are unknown but is a worthwhile area of research and potential innovation.

American College of Preventive Medicine: Addressing the Opioid Epidemic Through a Prevention Framework.

The opioid epidemic has resulted in significant morbidity and mortality in the U.S. Health systems, policymakers, payers, and public health have enacted numerous strategies to reduce the harms of opioids, including opioid use disorder (OUD). Much of this implementation has occurred before the development of OUD‒related comparative effectiveness evidence, which would enable an understanding of the benefits and harms of different approaches. This article from the American College of Preventive Medicine (ACPM) uses a prevention framework to identify the current approaches and make recommendations for addressing the opioid epidemic, encompassing strategies across a primordial, primary, secondary, and tertiary prevention approach. Key primordial prevention strategies include addressing social determinants of health and reducing adverse childhood events. Key primary prevention strategies include supporting the implementation of evidence-based prescribing guidelines, expanding school-based prevention programs, and improving access to behavioral health supports. Key secondary prevention strategies include expanding access to evidence-based medications for opioid use disorder, especially for high-risk populations, including pregnant women, hospitalized patients, and people transitioning out of carceral settings. Key tertiary prevention strategies include the expansion of harm reduction services, including expanding naloxone availability and syringe exchange programs. The ACPM Opioid Workgroup also identifies opportunities for de-implementation, in which historical and current practices may be ineffective or causing harm. De-implementation strategies include reducing inappropriate opioid prescribing; avoiding mandatory one-size-fits-all policies; eliminating barriers to medications for OUD, debunking the myth of detoxification as a primary solo treatment for opioid use disorder; and destigmatizing care practices and policies to better treat people with OUD.

Does social support mediate the moderating effect of intrinsic religiosity on the relationship between physical health and depressive symptoms among Jews?

Previous research in the general population suggests that intrinsic religiosity moderates (mitigates) the effect of poor physical health on depression. However, few studies have focused specifically on the Jewish community. We therefore examined these variables in a cross-sectional sample of 89 Orthodox and 123 non-Orthodox Jews. Based on previous research suggesting that non-Orthodox Judaism values religious mental states (e.g., beliefs) less and a collectivist social religiosity more, as compared to Orthodox Judaism, we hypothesized that the moderating effect of intrinsic religiosity would mediated by social support among non-Orthodox but not Orthodox Jews. As predicted, results indicated that the relationship between physical health and depression was moderated by intrinsic religiosity in the sample as a whole. Furthermore, this effect was mediated by social support among non-Orthodox Jews, but not among the Orthodox. The importance of examining religious affiliation and potential mediators in research on spirituality and health is discussed.

Randomized Controlled Study to Test the Effectiveness of Developmental Network Coaching in the Career Advancement of Diverse Early-Stage Investigators (ESIs): Implementation Challenges and Lessons Learned.

Introduction: Adding developmental networks (DN) to grant-writing coaching can significantly enhance ESIs' research careers. Herein, we present study design, ESIs' characteristics and encountered challenges/lessons learned and their resolutions when deploying/implementing (a) NCR algorithm(s), (b) recruitment/retention and (c) implementing DN intervention. Methods: Nested Cluster Randomization (NCR) design governs this study implementation. The sample size is 220 ESIs intending to submit an NIH K, R, U, and/or Minority Supplement application(s). Primary outcome: intensity/sustainability of grant submission(s)/funding(s), measured by time to/between application(s). Outcome(s) analyses modes: summaries, Kaplan Meir and Cox proportional hazard models as a function of randomization groups and other predictors of outcomes. Results: In the present study, we recruited two cohorts of ESIs (N = 85): 39% African Americans, 18% Latinx, 18% Whites, 20% Asians and 6% Hawaiian/Pacific Islander/other ethnicities; 65% are women; 73% are assistant professors, 4% are Associate Professors and 23% are instructors/scientists/post-doctoral. Participants' disciplines: 32% basic/biomedical, 36% clinical/translational and 32% social/behavioral. Proposal(s) mechanisms: 61% research grants (R series), 31% career development (K series), 7% support of competitive research (SCORE) and 1% National Science Foundation applications. NCR did produce balance in the distribution of ESIs' demographics, sex at birth, ethnicity, professional appointments, background disciplines, and mechanism of sought funding. Lessons learned/challenges: NCR implementation was methodologically challenged during implementation by added constraints (e.g., assigning coaches to the same randomization arm of their participants as well as blinding them to ESIs' randomization group). Recruitment and retention were hampered by the COVID-19 pandemic and more progressive and innovative strategies were needed to heighten the visibility and outreach of this program. DN delivery was also affected by the pandemic and monitoring of ESIs' engagement and facilitation of communications interventions were needed. Resolution of these challenges effectively reconfigured NCR algorithms, recruitment/retention plans, and DN intervention delivery. We intend to recruit an additional 135 ESIs focusing on underrepresented scholars from RCMIs, CTSAs, and other programs. COVID-19 rendered this program 100% virtual, with recruitment/retention challenges and substantial disruption of ESIs' research. We may extend the grant writing period, coaching, and Mock Study Section support.

Use of consumer wearable devices to promote physical activity among breast, prostate, and colorectal cancer survivors: a review of health intervention studies.

PURPOSE: A growing amount of research has successfully incorporated Fitbit devices and other wearable activity trackers into technology-oriented lifestyle interventions to increase physical activity among cancer survivors. METHODS: The present review of this literature is based upon bibliographic searches in PubMed and CINAHL and relevant search terms. Articles published in English from January 1, 2009, through October 16, 2019, were considered. RESULTS: A total of 1726 article citations were identified in PubMed and non-duplicates in CINAHL. After screening the abstracts or full texts of these articles and reviewing the references of previous review articles, we found 13 studies that met the eligibility criteria. Of these, 8 were randomized controlled trials, one was a pre-post-test trial, and 4 were qualitative studies (focus groups, in-depth interviews). The studies focused on breast cancer (n = 8), prostate cancer (n = 2), and colorectal cancer (n = 1), and the remainder focused on more than one cancer site. CONCLUSIONS: Additional research is needed to examine the efficacy of consumer wearable devices in promoting physical activity and weight management among cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS: Cancer survivors show an increase in physical activity when using consumer wearable activity trackers. Increased physical activity plays an important role in alleviating many adverse effects of breast cancer therapy as well as improving morbidity and mortality. Additional research such as clinical trials focused on the development of successful interventions utilizing these devices is warranted.

Electronic Nicotine Delivery Systems or E-cigarettes: American College of Preventive Medicine's Practice Statement.

INTRODUCTION: E-cigarettes or or electronic nicotine delivery systems (ENDS) have rapidly gained popularity in the U.S. Controversy exists about the safety and efficacy of ENDS. The American College of Preventive Medicine's Prevention Practice Committee undertook a consensus-based evidence review process to develop a practice statement for the American College of Preventive Medicine. METHODS: A rapid review of the literature was performed through June 2017 to identify efficacy, patient-oriented harms, and the impact on population health. RESULTS: On an individual level, limited evidence suggests that ENDS may be effective at reducing cigarette use among adult smokers intending to quit. There is insufficient evidence addressing potential long-term harms of ENDS, and limited evidence is available about short-term harms of ENDS and the impact of secondhand exposure. Although ENDS appear safer than combustible cigarettes, they are not without risk. Among youth there is no known benefit and significant concern for harm. On a population level, there may be significant harms associated with ENDS, particularly among youth nonsmokers. The long-term balance of potential benefits versus harms from the individual and population perspectives are unclear. CONCLUSIONS: The American College of Preventive Medicine developed practice recommendations that include encouraging screening for ENDS use, strategies to prevent the initiation of ENDS use in nonsmokers, particularly in youth, adoption of a harm reduction model for smokers intending to quit in those who refuse or fail to quit with evidence-based smoking-cessation methods, recommendations on policy and regulatory strategies to decrease public use of ENDS and regulation of their components, and future research needs.

The potential role of breast-feeding and other factors in helping to reduce early childhood caries.

OBJECTIVES: Dental caries is the most common chronic disease in US children. Early childhood caries (ECC) is particularly virulent and can interfere with a child's ability to eat, grow, speak, and communicate. Studies on whether breast-feeding or bottle-feeding are more likely to reduce ECC have proven inconclusive. METHODS: The study population included 175 children, aged 1 to 5, receiving dental care at the Hughes Spalding Children's Hospital in Atlanta, GA. Participation included a dental exam, chart data abstraction, and a personal interview with the mother. RESULTS: Too few exclusively breast-fed children prevented the adequate study of breast-feeding. However, children exclusively bottle-fed for at least 1.5 years had more decayed or filled tooth surfaces than children breast-fed part of that time but well short of a year. No bottle at night nor juice at irregular times, the mother's brushing of her child's teeth, and adequate dental care in the mother seemed to reduce ECC. CONCLUSIONS: Our results suggest measures that might reduce ECC risk. Medical providers must discuss oral health with new mothers and educate them on the important role they play in keeping their babies' teeth healthy

Abnormal mammogram follow-up: do community lay health advocates make a difference?

This pilot study evaluates a community lay health advocate (CLHA) intervention in promoting follow-up for abnormal mammograms among African American women. A controlled trial was implemented at an urban hospital in Atlanta, with 48 women in a CLHA intervention group and 35 in a usual care group. Participants were 25 or older and had an abnormal mammogram between March 25, 2002, and May 2, 2003. Intervention group women received CLHA support including encouragement of timely abnormal mammogram follow-up, reminders of follow-up appointments, identification and removal of barriers to follow-up, and accompaniment to follow-up appointments. Women in the intervention group were significantly more likely to keep their first abnormal mammogram follow-up appointment, all of their scheduled follow-up appointments, and their biopsy or fine needle aspiration appointment. CLHAs are effective in promoting abnormal mammogram followup among African American women and may be an important resource in reducing racial disparities in breast cancer mortality.

The need for culturally-tailored smartphone applications for weight control.

BACKGROUND: Approximately 35% of U.S. adults are obese, and this rate is expected to increase by almost 50% by 2030. New media such as smartphone applications (apps) provide a useful and low-cost way to disseminate weight control information. For many culturally distinctive population subgroups, however, there is currently an absence of research-tested smartphone apps for weight control. METHODS: In this commentary, we highlight the need for culturally tailored smartphone apps for weight control and offer recommendations for further research by providing two specific examples: 1) the characteristic dietary patterns and absence of smartphone apps for weight loss for Hispanic Americans, in English and Spanish, and 2) and need for smartphone apps for weight loss for Brazilian Americans, including those who speak Portuguese. RESULTS: Smartphone apps can be an effective intervention for improving diet and nutrition, encouraging physical activity, and reducing obesity, but few randomized controlled trials have been conducted of stand-alone smartphone apps for weight loss that focus primarily on self-monitoring of diet and physical activity. Further, there have been no published studies of apps for promoting healthy diet, better nutrition, increasing levels of physical activity, and weight loss among Hispanic Americans or Brazilian Americans. CONCLUSIONS: Low-cost, effective e-Health interventions (healthcare practices supported by electronic processes) are needed to promote physical activity, healthy eating, and weight control in culturally distinctive subgroups of the population. For weight loss, apps should be developed by use of evidence-based approaches that relate to behavioral theories. Additional public health research is needed to identify low-cost, effective strategies for weight loss for people who have varying levels of health literacy, and for non-English speakers. Culturally tailored e-Health interventions for weight control are more likely to address the needs of individuals and increase their motivation to engage in health promoting behaviors.

Reducing Disparities by way of a Cancer Disparities Research Training Program.

BACKGROUND: For minority populations, there is a continuing disparity in the burden of death and illness from cancer. Research to address this disparity should be conducted by investigators who can best understand and address the needs of culturally diverse communities. However, minorities are under-represented in health-related research. The goal of this project was to develop and evaluate an approach to motivating and preparing master's degree students for careers dedicated to cancer disparities research. METHOD: A Cancer Disparities Research Training Program (CDRTP) was initiated in 2010. The program consists of coursework, practicum experiences, and research opportunities. Assessment of the curriculum is based on monitoring achievement of evaluation indicators and included a mixed-method approach with included both quantitative and qualitative approach. RESULTS: In its first three years, the program graduated 20 trainees, all of whom were minorities (18 African Americans and two Asians). When asked about career goals, two-thirds of the trainees indicated interest in pursuing careers in research in cancer prevention and control. The trainees expressed high satisfaction with the courses, instructor, materials, and curriculum. Although trainees had suggestions about course details, evaluations overall were positive. Across focus groups, three recurrent themes emerged regarding activities to enhance the trainee experience: having a wider variety of topics, more guest speakers, and field trips. CONCLUSION: The CDRTP was intended to recruit students - primarily African Americans - into research on prevention and control of cancer disparities. Although final evaluation of the program's overall outcome will not be available for several years, this preliminary evaluation indicates early program success.

Barriers to occupational and environmental medicine services in the southeastern United States.

OBJECTIVES: We sought to determine whether low-income and minority populations in the Southeast face barriers to access to occupational and environmental medicine (OEM) services. METHODS: Access to OEM services was defined as the presence of an OEM physician in a county or the proximity of a clinic in the Association of Occupational and Environmental Clinics network to a county. RESULTS: Counties with higher percentages of low-income, all non-white minority, and African-American populations in South Carolina, Georgia, Alabama, and Mississippi were more likely to be farther away from an AOEC clinic. Counties with higher percentages of low-income populations were less likely to have an OEM physician. However, the percentages of minority and African-American populations in these counties were not associated with the presence of an OEM physician. CONCLUSION: Both low-income and minority populations in the Southeast face barriers to OEM services.

Validity of women's self-reports of cancer screening test utilization in a managed care population.

This study was undertaken to examine the validity of self-reported data on breast and cervical cancer screening behavior. An abbreviated version of the Behavioral Risk Factor Surveillance System telephone survey, including questions on mammography, clinical breast examination (CBE), and Papanicolaou test utilization, was administered to a sample of 480 women aged 40-74 years, enrolled in Kaiser Permanente Colorado for at least 5 years. Screening information reported in the telephone interview was compared with that abstracted from respondents' medical records. The vast majority of women had a mammogram, CBE, and Pap test according to both self-report and medical record. Sensitivity for determining whether her last test was within 2 years (3 years for Pap test) exceeded 95% for all, whereas specificities were <55%. The percentage of overall agreement between self-reported and recorded information was 88.4% (kappa = 0.62) for mammography, 87.9% (kappa = 0.45) for CBE, and 87.2% (kappa = 0.54) for Pap test. Pearson correlations between self-reported and recorded information for specific time interval since most recent mammogram, CBE, and Pap test were 0.72, 0.58, and 0.65, respectively. Correlation increased greatly when time interval was allowed to vary by +/-1 year. In most cases of disagreement, the self-report underestimated the time since last screening. These results suggest that self-reporting of breast and cervical cancer screening is fairly accurate in this managed care population, although women tend to underestimate the time since their last screening.

An empirical study of the use of living versus deceased study subjects: associations with liver cancer in the selected cancers study.

PURPOSE: In case-control studies, the issue of whether living or deceased controls should be used for deceased cases has been controversial. METHODS: Using data from a study of cancer among men that selected both live (n = 1910) and deceased controls (n = 596) for cases of liver cancer (109 deceased, 59 living), we examined the effects of using information from proxy respondents (cases and controls) and from live cases and controls on associations between liver cancer and known risk factors. Cases diagnosed between 1984 and 1988 were selected from eight population-based cancer registries. Live controls were recruited by random digit dialing, deceased controls from death certificate files. Controls were matched to cases on geographic area, year-of-birth, and race. RESULTS: Adjusted odds ratios (OR) calculated for deceased cases and controls, when compared to odds ratios for live cases and controls, were attenuated towards the null value for history of hepatitis (4.7 vs. 14.9), blood transfusions (1.1 vs. 7.8), and cirrhosis (9.3 vs. 51.1). When all cases and living controls were used, odds ratios did not differ substantially from those for living cases and controls except for cirrhosis (OR = 154.2). For smoking, the odds ratios were similar in all analyses. Adjustment for type of interview (self, proxy) did not eliminate differences between results for living and deceased subjects; significant interactions were found between type of interview and hepatitis, cirrhosis, and blood transfusions. CONCLUSIONS: Selection of live controls for deceased cases is recommended to decrease misclassification in measures of exposure.