ABSTRACT
Introduction : African Americans are disproportionately affected by mortality risk for colorectal cancer (CRC). This study aimed to determine the most effective educational approach of four study arms that enhances the likelihood of pursuing subsequent CRC screening, and to identify the associated factors. Methods : Age-eligible adults (N = 2877) were recruited to participate in a cluster randomized control dissemination and intervention implementation trial entitled Educational Program to Increase Colorectal Cancer Screening (EPICS). The project began in May 2012 and ended in March 2017 (the implementation phase lasted for 36 months). Educational sessions were conducted through 16 community coalitions that were randomized into one of four conditions: website access (to facilitator training materials and toolkits) without technical assistance (WA-TA), website access with technical assistance (WA+TA);in-person training (provided by research staff and website access) without technical assistance (IP-TA);and in-person training with technical assistance (IP+TA). A follow-up to determine participant CRC screening was conducted three months later. Results : Compared to the WA+TA intervention group the two groups of IP+TA and IP-TA indicated significantly higher odds for obtaining CRC screening (OR (95% CI): 1.31 (1.04,1.64);p-value= 0.02 and 1.35 (1.07,1.71);p-value= 0.01, respectively). Though sociodemographic factors were not significantly associated with pursing subsequent CRC screening, the post intervention cancer knowledge increased significantly among the study participants. Conclusions : The importance of in-person interactions, local coalitions and community contexts may play a key role for successfully increasing CRC screening rates among African Americans as reflected through this study. The integration of telehealth and use of other virtual technologies to engage the public in research have increased since the COVID-19 pandemic and should be assessed to determine their impact on the degree to which in-person intervention are significantly more effective when compared to solely web assisted.
ABSTRACT
Background Vaccine uptake concerns in the Unites States were at the forefront of public health discussions during the COVID-19 pandemic. By the end of 2022, approximately 80% of the U.S. population was vaccinated against the virus. This study examined the relationship between perceived social support and COVID-19 vaccine uptake among U.S. adults. Methods Using nationally representative cross-sectional data on 21,107 adults from the 2021 National Health Interview Survey, we assessed the COVID-19 vaccination rates across individuals with strong, some, and weak levels of social support. Multivariable logistic regression models were estimated to obtain the odds of being vaccinated in adults with different levels of perceived social support for the full sample and sub-samples of age groups. Results We found that compared to adults with perceived strong social support, adults with weak social support were 21.1% less likely to be vaccinated against COVID-19. Apart from the age 18-24 years group, the lower likelihood of being vaccinated for adults with weak social support was evident in age 24-49 years (AOR=0.66, 95% CI: 0.52-0.85), age 50-64 years (AOR=0.67, 95% CI: 0.50-0.90), and age 65+ years (AOR=0.56, 95% CI: 0.41-0.75) groups. Conclusions These findings are consistent with a broader literature indicating that social support increases the likelihood of healthy behaviors and decreases risky behaviors. Interventions designed to improve the perception of social support, particularly among those at high risk of mortality from COVID-19 may be a promising tactic for increasing COVID-19 vaccine uptake. Graphical Image, graphical
ABSTRACT
BACKGROUND: The surge in the COVID-19 related hospitalization has been straining the US health system. COVID-19 patients with underlying chronic conditions have a disproportionately higher risk of hospitalization and intensive care unit (ICU) admission. We developed a retrospective analytical model of COVID-19 related hospitalizations and ICU admissions linked to each of the three major chronic conditions - hypertension, diabetes, and cardiovascular diseases (CVD). METHODS: Based on the differential probability of hospitalization of the COVID-19 patients with and without a chronic condition, we estimate a baseline cumulative hospitalization rate and ICU admission rate using the population level chronic condition prevalence from the 2019 Behavioral Risk Factor Surveillance System survey. Next, we estimate the hospitalization and ICU admission rates under an alternative scenario of a lower prevalence of the same chronic condition, aligned with the World Health Organization target of 25% relative reduction of prevalence by 2025. We then compare the outcomes of the baseline and the alternative scenarios. RESULTS: We estimate that the lower prevalence of hypertension would have lowered the cumulative hospitalization and ICU admission rates by more than 2.5%. The lower prevalence of diabetes and CVD would lower the cumulative hospitalization rate by 0.6% and 1.4% respectively. The decrease in the rates would have been relatively higher among Black and elderly (age 55+). CONCLUSIONS: Our model, thus, provides evidence on the importance of prevention, control, and management of chronic conditions to lessen the overwhelming financial and public health burden on the health system during a pandemic like the COVID-19.