Health information-seeking behavior among Congolese refugees.

BACKGROUND: The purpose of this cross-sectional study was to determine the extent to which Congolese refugees seek health information, to identify and assess the resources used while exercising Health Information-Seeking Behavior (HISB), and to identify individual determinants that affect their HISB. METHODOLOGY: Building Bridges program participants who resided in Texas between 2017-2020, reported country of origin as Democratic Republic of Congo, and responded to HISB questions were included in this study. Four HISB questions asked about frequency seeking health information, preferred source and perceived trustworthiness of source, and frequency worrying about their health. Associations between HISB and sociodemographic factors (age, gender, education years, years in US, proficiency speaking English, marital status) were tested using Pearson chi-square or Fisher's exact tests (α≤0.05). RESULTS: Most participants (59%) reported seeking health information sometimes. Less than half (44%) of participants identified doctors as their preferred source of health information, Twenty-five percent relied on family, friends, and community leaders, and 23% used media sources. Doctors were identified as the most trustworthy source (71%), family and friends were the second highest trusted source (25%), whereas media sources were the least trusted (4%). Sociodemographic factors age (p = .02), gender (p < .01), and education years (p < .01) were the only significant predictors of preferred information sources. Conversely, those residing in US <5 years were more likely to seek health information more frequently (p = .01). The majority of participants did not worry about their health, and it was not significantly associated with source or frequency of seeking health information. CONCLUSIONS: The high trust in doctors represents an opportunity for healthcare professionals to educate and address individual barriers contributing to refugees' underutilization of preventive care services such as routine immunizations and preventive health screenings.

Alcohol use among Congolese Babembe male refugees in Tarrant County: A qualitative study.

BACKGROUND: Refugees are at high risk of alcohol abuse due to experiences in their country of origin, transit camps, and in host countries. Congolese have been the largest group of refugees resettled in the US since 2016 and Babembe represent one of the largest Congolese refugee sub-groups. There is a growing body of literature highlighting substance abuse among refugees resettled in the US, but little is known about Congolese Babembe. This study aimed to explore factors and practices contributing to alcohol abuse among Congolese Babembe refugees. METHODS: A qualitative research design employing a narrative inquiry approach was used in this study. One focus group discussion was conducted with a semi-structured guide in February 2020.A total of 19 hard-to-reach male refugee participants were recruited through snowball sampling. Audio recordings were translated and transcribed before a thematic content analysis was conducted using Nvivo 10. RESULTS: The main themes arose in the focus group analysis. First, the role of war, trauma, and migration in the onset of alcohol abuse in a community that once limited alcohol use to only older men for socialization. Second, refugees viewed alcohol abuse in their community as a result of post- resettlement cultural loss. Third, refugees perceived alcohol as serving a purpose to help cope with stressful conditions in the US and bad news received from loved ones in Africa. Further analysis shows the role of interactions with armed forces and other cultures during war and migration contributed to the adoption of alcohol abuse behavior. CONCLUSION: Findings from this study suggest that factors contributing to alcohol abuse among Congolese Babembe refugees include personal traumatic experiences, loss of cultural identity, and conducive conditions in the host country. Understanding these factors can guide the development of appropriate interventions to prevent alcohol abuse in this vulnerable community. Further research is needed to include Babembe women's perspectives.

Willingness of a Multiethnic Immigrant Population to Donate Biospecimens for Research Purposes.

This cross-sectional study explores the willingness to donate biospecimens for research purposes among six refugee communities in North Texas (spanning Myanmar, Central Africa, Somalia, Nepal, Arabic speaking countries, and others). Participants were asked four questions about biospecimen donation: (1) previously asked to donate, (2) ever agreed to donate, (3) willingness to donate for future research, and (4) what samples they would be willing to donate. Most participants (77%) were willing to donate biosamples for medical research; 58% were willing to donate samples. Fewer refugees from Somalia were willing to donate compared to immigrants from Myanmar, Central Africa, and Nepal (p < 0.01). Participants in the older age group (40 + years) were 3.2 times more likely to be willing for donation of biospecimens than the younger ones (OR 3.22, 95% CI 1.22, 8.55). Findings suggest refugees' willingness to participate in biospecimen donation which support intentional inclusion of multicultural populations into medical research.

Hepatitis B Virus Awareness, Infection, and Screening Multiethnic Community Intervention for Foreign-Born Populations.

Hepatitis B virus (HBV) is a potentially deadly viral infection that can lead to liver cancer. Many refugee immigrants resettled in the US come from countries known to have a high prevalence of HBV infections. Unfortunately, most infected refugee immigrants are unaware of their HBV status. The disease is highly preventable through a vaccine, but chronic HBV is incurable once the disease has developed. For the purposes of this cross-sectional study, we conducted analysis of data collected through the Building Bridges Initiative (BBI) to assess HBV awareness, vaccination status, screening, and infection among multiethnic, primarily refugee, immigrant populations living in North Texas. Overall, 74% of study participants reported having heard about HBV, but only 31% knew their HBV status. Whereas 69% of study participants lacked awareness about their HBV status and self-reported prevalence of chronic HBV among study participants was 4%. For the vaccine, only 26% reported to have received at least one dose; 53% did not know, while 21% had not ever received it. For those unaware of their HBV status, the BBI offered participants free HBV screening and assistance for vaccination as needed. 76% of participants that accepted HBV screening from BBI were never screened before (enrollment in BBI). Chronic HBV positivity rate for participants was 6%, which is twenty times higher than the national prevalence of chronic HBV (0.3%). High prevalence of HBV, low awareness and low vaccination rates seen in this study highlights the need for increased HBV prevention among foreign born populations.

Understanding the Interplay Between Health Disparities and Epigenomics.

Social epigenomics has emerged as an integrative field of research focused on identification of socio-environmental factors, their influence on human biology through epigenomic modifications, and how they contribute to current health disparities. Several health disparities studies have been published using genetic-based approaches; however, increasing accessibility and affordability of molecular technologies have allowed for an in-depth investigation of the influence of external factors on epigenetic modifications (e.g., DNA methylation, micro-RNA expression). Currently, research is focused on epigenetic changes in response to environment, as well as targeted epigenetic therapies and environmental/social strategies for potentially minimizing certain health disparities. Here, we will review recent findings in this field pertaining to conditions and diseases over life span encompassing prenatal to adult stages.

Uptake of cancer screenings among a multiethnic refugee population in North Texas, 2014-2018.

BACKGROUND: Refugees are less likely than US born populations to receive cancer screenings. Building Bridges is a community health worker prevention program designed to increase refugee's cancer screening uptake. The purpose of this cross sectional analysis was to assess differences in uptake of cervical, breast, liver, and colorectal screens across six cultural groups. METHODS: Data was abstracted in 2018 for this analysis. Participants were categorized into six cultural groups (Myanmar, Central Africa, Bhutan, Somalia, Arabic Speaking Countries, and Other) to assess differences in sociodemographic measures and screening uptake. Uptake proportions were calculated for each cancer type (cervical, breast, liver, and colon) among eligible participants, by gender and cultural group. Differences in uptake across groups were assessed using stratified analysis and logistic regression. Prevalence odds ratios (POR) and 95% confidence intervals (CIs) were calculated for each group to assess the association between screening completion and cultural group. FINDINGS: 874 refugees were asked about cancer screening history. The majority of participants were either 'never had been screened' or 'not up-to-date' for every cancer screening. Among age eligible, 82% had no prior pap exam within the past 3 years, 81% had no prior mammogram within the past year, 69% didn't know their Hepatitis B status and 87% never had a colon cancer screening. Overall, higher uptake of all types of cancer screenings was observed in Myanmar and Bhutanese groups, except colon cancer screening which was higher among Central African Region and Arabic Speaking participants. CONCLUSION: Screening uptake varied by ethnic group and screening type. The program reached an under and never screened population, however, the proportion of refugees who received a cancer screening remained low compared to the US population. Diversity within refugee communities requires adaptation to specific cultural and linguistic needs to include new Americans in cancer elimination efforts.

A case-cohort study of lung cancer in poultry and control workers: occupational findings.

OBJECTIVES: We conducted a mortality study of members of the United Food and Commercial Workers International Union who worked in poultry slaughtering/processing plants, and controls. Excess deaths from cancer at 11 different cancer sites including lung cancer were observed in the poultry workers. The study described here is a pilot case-cohort study of lung cancer nested within the cohort to examine if it is possible, in a larger study to be conducted later, to identify specific potentially carcinogenic occupational exposures in poultry workers. METHODS: Subjects or the next of kin of deceased subjects were interviewed by phone. Logistic regression ORs and Cox proportional HRs were estimated. RESULTS: Elevated risks for poultry exposure were recorded for subjects who (1) killed chickens at work (OR 4.2, 95% CI 1.2 to 14.7; HR 1.8, 95% CI 1.0 to 3.3) and (2) ever had direct contact with chicken blood at work (OR 1.9, 95% CI 1.0 to 3.8; HR 1.3, 95% CI 0.9 to 2.0). These activities are associated with high exposure to oncogenic viruses. CONCLUSION: These results may have important public health implications, since the general population is also exposed to these viruses. Elevated risks were observed for non-poultry-related occupational exposures such as working in a stockyard, working in a chemical plant, use of chemicals to kill moulds, and working in plants where plastic products were manufactured. These preliminary findings indicate that full scale epidemiological studies of adequate statistical power are needed to examine the role of occupational exposures in cancer occurrence in poultry workers.

A pilot case-cohort study of liver and pancreatic cancers in poultry workers.

PURPOSE: To test the hypothesis that exposure to poultry oncogenic viruses that widely occurs occupationally in poultry workers and in the general population, may be associated with increased risks of deaths from liver and pancreatic cancers, and to identify new risk factors. METHODS: A pilot case-cohort study of both cancers within a combined cohort of 30,411 highly exposed poultry workers and 16,408 control subjects was conducted, and risk assessed by logistic regression odds ratios (OR) and proportional hazards risk ratios. RESULTS: New occupational findings were recorded respectively for pancreatic/liver cancers, for slaughtering of poultry (OR = 8.9, 95% confidence interval [CI]: 2.7-29.3)/OR = 9.1, 95% CI: 1.9-42.9); catching of live chickens (OR = 3.6, 95% CI: 1.2-10.9)/OR = 1.0, 95% CI: 0.1-8.5); killing other types of animals for food (OR = 4.8, 95% CI: 1.5-16.6)/OR = 2.0, 95% CI: 0.2-18.2), and ever worked on a pig raising farm (OR = 3.0, 95% CI: 1.0-8.2) for pancreatic cancer only. New non-occupational findings for liver cancer were for receiving immunization with yellow fever vaccine (OR = 8.7, 95% CI: 1.0-76.3); and vaccination with typhoid vaccine (OR = 6.3, 95% CI: 1.1-37.4). The study also confirmed previously reported risk factors for both diseases. CONCLUSIONS: This study provides preliminary evidence that exposure to poultry oncogenic viruses may possibly be associated with the occurrence of liver and pancreatic cancers. Case-control studies nested within occupational cohorts of highly exposed subjects of sufficient statistical power may provide an efficient and valid method of investigating/confirming these findings.

Mortality in workers employed in pig abattoirs and processing plants.

OBJECTIVE: workers in slaughterhouses and processing plants that handle pigs, and pork butchers/meatcutters have been little studied for health risks associated with employment, in spite of the fact that they are potentially exposed to oncogenic and non-oncogenic transmissible agents and chemical carcinogens at work. We report here on an update of mortality in 510 workers employed in abattoirs and processing plants that almost exclusively handled pigs and pork products. METHODS: standardized mortality ratios (SMRs) were estimated for the cohort as a whole, and in subgroups defined by race and sex, using the corresponding US general population mortality rates for comparison. Study subjects were followed up from January 1950 to December 2006, during which time 45% of them died. RESULTS: mortality was significantly increased overall in the cohort. A statistically significant excess of deaths was observed for colon and lung cancers in the entire cohort, SMR=2.7 (95% CI, 1.2-5.1), SMR=1.8 (95% CI, 1.1-2.7), respectively. Significant SMRs in the cohort as a whole were also observed for senile and pre-senile psychotic conditions (SMR=5.1, 95% CI, 1.4-13.1), and pneumonia (SMR=2.6, 95% CI, 1.3-4.8). An observed excess of subarachnoid hemorrhage was seen mainly in whites (SMR=10.1, 95% CI, 1.2-36.3). There was a suggestion of an excess of deaths from ischemic heart disease also, but the elevated SMR was confined to men and was not statistically significant. CONCLUSION: this study confirms the excess occurrence of lung and colon cancers, and stroke previously reported in this occupational group. New findings are the excess of risk for senile and pre-senile psychotic conditions and pneumonia, which together with the excess of colon cancer appear specific for pig/pork workers, as they were not evident in much larger studies of workers in abattoirs and processing plants handling cattle and sheep. However, caution should be exercised in interpreting these findings, since some of them could have occurred by chance, resulting from our examination of a large number of causes of death in multiple study subgroups. For the moment, the significance of these findings remains unknown until they are confirmed in larger studies of adequate statistical power. Studies that will take into account possible occupational and non-occupational confounding factors are needed.

Update of cancer and non-cancer mortality in the Missouri poultry cohort.

BACKGROUND: workers in poultry slaughtering and processing plants have one of the highest human exposures to transmissible agents that cause cancer and other diseases in chickens and turkeys, and also have other occupational carcinogenic exposures. The general population is also exposed to these transmissible agents. METHODS: we investigated mortality in workers who belong to a poultry union in Missouri, and estimated standardized mortality ratios. RESULTS: significantly increased mortality was observed for some leukemias, benign neoplasms, thyroid diseases, bacterial infections, and schizophrenic disorders. The risk of breast cancer and several non-cancer conditions was significantly depressed. CONCLUSION: the findings add to the growing evidence suggesting that workers occupationally exposed to transmissible agents and carcinogens in the poultry industry, are at increased risk of dying from certain chronic diseases, including cancer.

The association between renal cell carcinoma and multiple myeloma: insights from population-based data.

OBJECTIVE: • To evaluate the hypothesis of an association between renal cell carcinoma and multiple myeloma. PATIENTS AND METHODS: • Data from nine population-based registries in the Surveillance, Epidemiology and End Results programme were used to evaluate two separate cohorts of patients diagnosed between 1973 and 2006: patients diagnosed with renal cell carcinoma as a primary malignancy (n= 57,190) and patients diagnosed with multiple myeloma as a primary malignancy (n= 34,156). • We estimated standardized incidence ratios (SIRs) with corresponding 95% confidence intervals (CIs) by dividing the number of observed cases of multiple myeloma within the renal cell carcinoma cohort and the number of renal cell carcinoma cases within the multiple myeloma cohort by the number of expected cases for each malignancy in the US general population. RESULTS: • The renal cell carcinoma cohort yielded 88 multiple myeloma cases during 293,511 person-years of follow up. Patients with renal cell carcinoma had a higher relative risk of multiple myeloma than the general population (SIR = 1.51, 95% CI 1.21-1.85). • The multiple myeloma cohort yielded 69 renal cell carcinoma cases during 100,804 person-years of follow up. Patients with multiple myeloma had a higher relative risk of renal cell carcinoma than the general population (SIR = 1.89, 95% CI 1.47-2.40). CONCLUSION: • Our analyses revealed a bidirectional association between renal cell carcinoma and multiple myeloma, which typically indicates shared risk factors.

The health care provider's role and patient compliance to health promotion advice from the user's perspective: analysis of the 2006 National Health Interview Survey data.

OBJECTIVE: The recommendations of health care providers have been shown to be a predictor of future healthy behaviors. However, patient adherence to these recommendations may differ based upon the type of health care professional providing the information. This study explored patient compliance in the United States over a 12-month period and contracted the patient response to recommendations given by chiropractors versus medical doctors. METHODS: Multiple logistic regression models were used for analyses of data from the Sample Adult Core component of the 2006 National Health Interview Survey (n = 24 275). Analyses were performed separately for recommendation and compliance of weight loss, increase exercise, and diet change by health profession subtype (chiropractor and medical doctor). RESULTS: About 30.5% of the respondents reported receiving advice from their provider. Among these, 88.0% indicated they complied with the advice they received. Patients who were advised were more likely to comply (odds ratio [OR] [95% CI], 10.41[9.34-11.24]). Adjusting for seeing a physical therapist, age, and body mass index, chiropractors were less likely to advice patients compared to medical doctors (OR [95% CI], 0.38 [0.30-0.50]). In general, there was a 21% increased odds that patients who received and complied with health promotion advice from their health care provider would report an improved health status (OR [95% CI], 1.21 [1.10-1.33]) compared with those who did not comply or were not advised. CONCLUSION: Chiropractors in the United States give health promotion recommendation to their patients but are less likely to do so than general medical doctors. Patients tend to comply with health providers' recommendations and those who do report better health.

Chiropractic and medical use of health promotion in the management of arthritis: analysis of the 2006 National Health Interview Survey.

OBJECTIVE: The importance of integrating healthy behavior counseling into routine health care is universal but may depend on the type of medical care provider as well as the conditions presented by patients. The purpose of this study was to evaluate whether health promotion (HP) recommendations for known risk factors of arthritis differed between general medical doctors and doctors of chiropractic (DCs) in a nationally representative US population with arthritis. METHODS: Multiple logistic regression models were used for analyses of data from the Sample Adult Core component of the 2006 National Health Interview Survey (n = 6374 diagnosed with arthritis). Analyses were performed separately for recommendation of weight loss and increase in exercise by health profession subtype (chiropractor and medical doctor). RESULTS: Comparing the reported HP efforts between DCs and medical doctors (MDs), while adjusting for the effect of physical therapist and body mass index, we observed no significant differences (weight loss: adjusted odds ratio [95% confidence interval] = 0.76 [0.50-1.18]; increased exercise: adjusted odds ratio [95% confidence interval] = 0.87 [0.59-1.29]). CONCLUSION: Health promotion efforts to patients with arthritis do not differ significantly between MDs and DCs, as reported by National Health Interview Survey 2006. This investigation makes it difficult to suggest that DCs or MDs are doing all they can do to manage arthritis through suggested modification of lifestyle in their patients. More research specific to what is and can be recommended to those with arthritis should be conducted particularly because it relates to health-promoting behaviors. Given the recent implementation of required clinical competencies in HP into chiropractic college curriculums, future studies regarding translation of HP messages into public practice should be more informative.

Acute myeloid leukemia incidence following radiation therapy for localized or locally advanced prostate adenocarcinoma.

INTRODUCTION: The effect of radiation therapy on acute myeloid leukemia incidence among prostate cancer patients has not been sufficiently elucidated despite evidence that acute myeloid leukemia is a consequence of therapeutic radiation in other primary malignancies. Therefore, we investigated the effect of definitive therapy with radiation therapy (external beam radiation therapy [EBRT] or brachytherapy) on acute myeloid leukemia incidence in a population-based cohort of patients with localized or locally advanced prostate cancer. METHODS: We utilized the Surveillance, Epidemiology, and End Results database to identify a cohort of men (n=168,612) with newly diagnosed prostate adenocarcinoma between January 1988 and December 2003. Cox proportional hazard regression was used to estimate the hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) of acute myeloid leukemia incidence following definitive therapy with EBRT alone, brachytherapy alone, or surgery alone compared to no definitive therapy (i.e. no EBRT, brachytherapy, or surgery). RESULTS: The cohort yielded 184 acute myeloid leukemia cases during 1,064,820 person-years of follow-up after prostate adenocarcinoma diagnosis. Patients treated with EBRT had a higher adjusted relative risk of developing acute myeloid leukemia than patients treated with brachytherapy or surgery when each therapy group was compared to patients who were not treated with definitive therapy (EBRT: HR=2.05, 95% CI 1.29, 3.26; brachytherapy: HR=1.22, 95% CI 0.46, 3.22; surgery: HR=1.24, 95% CI 0.77, 1.98). CONCLUSIONS: Our findings suggest that acute myeloid leukemia incidence is a greater concern for patients treated with EBRT than brachytherapy for localized or locally advanced prostate adenocarcinoma.

Reproductive factors and hormone use and risk of adult gliomas.

Previous research suggests there may be a hormonal influence on glioma risk as evidenced by lower rates in females, change in incidence rates around ages at menarche and menopause, and presence of hormone receptors in glial tumors. Using the large San Francisco Bay Area Adult Glioma Study, we investigated whether reported reproductive factors and hormone use were associated with gliomas overall or with histologic subtypes among female cases (n = 619) and controls (n = 650). We found that reproductive factors were generally not associated with gliomas. Weak to moderately elevated odds ratios were observed for self-reported later age at menarche (14+ vs. 12-13 years old: adjusted odds ratio (AOR) = 1.39, 95% confidence interval (CI): 1.02-1.89), particularly for non-glioblastoma histologies (AOR = 1.64, 95% CI: 1.11-2.43). Inverse associations were observed for ever self-reported use of exogenous hormones (oral contraceptive use: AOR = 0.72, 95% CI: 0.53-0.99; postmenopausal hormone use: AOR = 0.56, CI: 0.37-0.84). However, cumulative hormone exposure defined multiple ways demonstrated no clear pattern of association. The results of this study suggest that any protective effect of hormones on gliomas may be limited to exogenous hormones, but a more detailed history of exogenous hormone use is needed to confirm findings.

DNA repair polymorphisms XRCC1 and MGMT and risk of adult gliomas.

X-ray cross complementing group 1 (XRCC1) and O6-methylguanine-DNA methyltransferase (MGMT) are pivotal repair genes focused on repairing lesions due to ionizing radiation, alkylating agents, and oxidative DNA damage, risk factors previously linked to gliomas. Using the population based San Francisco Adult Glioma study, we evaluated associations between XRCC1 Arg399Gln, MGMT Leu84Phe, and MGMT Ile143Val polymorphisms with glioma risk among white cases (n = 441 to 453) and controls (n = 487 to 526). We found no evidence of an association between XRCC1 genotypes and glioma. We observed a weak positive association for the MGMT Leu84Phe polymorphism (Leu or Phe/Phe versus Leu/Leu: adjusted OR = 1.26; CI 0.90-1.75) and the MGMT Ile143Val polymorphism (Ile or Val/Val versus Ile/Ile: adjusted OR = 1.20; CI 0.85-1.71).

Occupation and adult gliomas in the San Francisco Bay Area.

The etiology of gliomas is not well understood. Some jobs might involve sustained and elevated exposures to carcinogens. This study compares lifetime job histories of 879 glioma cases diagnosed between August 1991 to April 1994 and May 1997 to August 1999 in the San Francisco Bay Area and 864 controls. Logistic analyses compared longest and ever held occupations of 1 year or more for all astrocytic and nonastrocytic cases and controls overall with adjustment for age, gender, and ethnicity and separately for men and women. Two-fold or higher or statistically significant elevated odds ratios were found overall and in men among those with longest held occupations, as firefighters, physicians, material moving equipment operators, and janitors; such elevated odds ratios were also observed for longest-held occupations among male motor vehicle operators and personal service workers and female messengers, legal/social service workers, electronic equipment operators, painters, and food processors. Odds ratios of 0.50 or less, but not statistically significant, were found for those with longest held jobs as writers/journalists, biological scientists, paper workers, mechanics, chemists, and photographers/photoprocessors. This study supports previously observed occupational associations and is one of the few studies with sufficient numbers to separately analyze occupations by gender.