Rozprawy doktorskie na temat „United States. Public Health Survey”

BACKGROUND: Though significant gains have been made in preventing cervical cancer over the past 30 years, it continues to cause morbidity and mortality among women in the United States, particularly among those women who are screened infrequently or not at all. More than half of cervical cancer deaths in the U.S. are among immigrants, and the incidence and mortality from cervical cancer is increasing among foreign-born women. Arab and Hispanic women living in the U.S. continue to have cervical cancer screening rates that are lower than the general population. Understanding what factors influence their cervical cancer screening practices and what new screening options may overcome their barriers to preventive screening may be effective in reducing disparities in the disease burden of cervical cancer.

HPV DNA testing has taken on a larger role in cervical cancer screening, and there is increasing evidence and support for the use of HPV testing alone as a primary cervical cancer screening test. Novel health screening devices have been developed that allow women to self-screen for HPV, which may offer opportunity to simplify the cervical cancer screening protocol and reach women who are not receiving recommended cervical cancer screening services.

OBJECTIVE: Because self-administered screening devices are not yet available and most women have not had exposure to them, there are limited quantitative and qualitative assessments of women's attitudes towards and likelihood to use such devices, particularly in the U.S. This study informs the development of culturally appropriate interventions and policies intended to improve cervical cancer screening rates among Arab and Hispanic women in the United States, and discusses implementation challenges and policy implications associated with incorporating self-administered HPV testing into the cervical cancer screening protocol in the U.S.

METHODS: A paper-based survey (n = 476) and individual interviews (n = 31) were used to explore Arab and Hispanic participants' screening behaviors, their likelihood to use HPV self-administered tests to screen for cervical cancer, their perceived self-efficacy in using self-screening tests, and the major concerns they have about self-screening.

RESULTS: Participants who were 1) uninsured, 2) knowledgeable about HPV and cervical cancer, 3) had high self-efficacy in their ability to use a self-screening test; and 4) had no concerns about the self-screening test were significantly more likely to use a self-screening test. Hispanic participants (74.0%) were significantly more likely than Arab participants (43.8%) to report they would be likely to use a self-administered cervical cancer screening test if it were available. Approximately half of uninsured (52.7%) and underscreened (47.1%) participants reported they would be more likely to get screened for cervical cancer if an at-home self-screening test were available.

CONCLUSIONS: A majority of participants responded positively to the option for HPV self-testing as a cervical cancer screening option, suggesting that it may an effective screening modality to reach women who are not accessing routine screening. More research is needed on implementing a self-screening option, particularly among underscreened populations.

More than half of the incidents and mortality rates from cervical cancer occur among minority groups, including immigrant women from continental Africa living in the United States. Although researchers have examined cervical cancer screening practices among minority populations, including Black women in Africa and in the United States, there are few studies on cervical cancer screening and associated risk factors, specifically among African women living in the United States. The purpose of this study was to investigate the association between selected factors and cervical cancer screening practices among African immigrant women living in the United States. Using the behavioral model for vulnerable populations as a theoretical basis, this cross-sectional quantitative study was focused on determining the association between family income, level of education, language of interview, insurance status, age, and perceived health status and cancer screening practices. Data on 572 African immigrant women from the National Health Interview Survey in 2005, 2008, and 2010 were used for the study. Chi-square tests and logistic regression were used to analyze the data. Key findings indicate that family income, education level, and age were significantly associated with cervical cancer screening practices among African immigrant women in the United States. Findings from the study support positive social change by targeting at-risk groups for cervical cancer screening programs. The long-term goal of early cervical cancer screening is to lower cervical cancer rates among African immigrant women in the United States. The findings from the study can be used by community health professionals to provide education that can lead to utilization of cervical cancer screening services based on guidelines and recommendations.

Despite the trends showing a reduction in the use and abuse of drugs among American adolescents, the prevalence rates remain high. There is also comorbidity of mental illnesses among the adolescents using drugs. The aim of this study was to determine the presence and nature of the association between the use and abuse of marijuana and alcohol and mental illnesses among the American adolescent population. The noted comorbidities and the hypothesized association between the substance abuse and mental illnesses were explained using the expectancy theory. Using a quantitative research methodology, secondary data from the National Survey on Drug Use and Health for 2014 and 2015 were analyzed. Data analysis yielded a positive but weak association between use and abuse of alcohol and marijuana through proxies such as marijuana use in the past month (p = 0.01), first use of marijuana ( p = 0.016), alcohol use disorder in the past year (p = 0.002), alcohol dependence in the past year (p = 0.001), and the occurrence of mental illnesses. The association was statistically significant in all proxies except alcohol use in the past month. F-test results were also statistically significant (p = 0.022, R² = 0.242). The findings showed that adolescents who used marijuana and alcohol were more likely to develop mental illnesses. It is recommended for relevant federal and state governments and public health agencies to develop social programs to address the two issues inclusively rather than exclusively.

Type 1 diabetes (T1D) is a chronic and lifelong condition, often diagnosed in childhood. Patients with T1D are at elevated risks of associated health complications, comorbidities, and mortality. Occurrence, clinical presentation, and complications related to T1D differ by age of onset, ethnicity, and gender. The last reported population-based estimates regarding the burden of T1D in children using the National Health and Nutrition Examination Survey (NHANES) were published in 2008, and these estimates were not well stratified by age of onset, ethnicity, and gender. The purpose of this study was to examine these demographics within the conceptual framework of the hygiene hypothesis using data from NHANES from 1999 to 2012. A cross-sectional study design was used to determine the average age of onset of T1D with respect to ethnicity and gender and to assess if age of onset is associated with ethnicity and gender. The average age of onset was 10.5 years for males and 11.8 years for females. The average age of onset was 13.0 years for Hispanics, 12.7 years for Non-Hispanic Blacks, and 10.6 years for Non-Hispanic Whites. Regression analysis indicated that there was no significant association between age of onset and gender (β = 1.1, p = 0.386) and between age of onset and ethnicity (β = 2.1, p = 0.070 for Hispanic White; β = 1.9, p = 0.101 for Non-Hispanic Black) having considered the Non-Hispanic White as the reference population. The result of this study may contribute to positive social change by providing better insight on demographic determinants of the risk of T1D, which is crucially important in the planning and implementation of prevention measures in highly susceptible populations.

Purpose: To examine if disparities exist among US adults aged 40 and above that reported reasons for no access to eye care.

Methods: A secondary analysis was conducted on 14,129 US adults aged 40 and above who responded to the Vision Module of the 2007 BRFSS using cross-tabulations, logistic regression and chi square statistics.

Results: Respondents reporting cost/insurance as the main reason for not accessing an eye doctor was greater among adults with education level < HS than with > HS (p<0.001). The percentage who reported cost/insurance as the main reason was greater among adults with income < $25,000 than with >$50,000 (p<0.001). Similarly, a greater percentage of Black adults reported cost/insurance as the reason for not accessing an eye doctor compared to White adults.

Conclusion: Given that Cost/Insurance was the most frequently cited reason, making eye health/health insurance available to most or all Americans will go a long way in narrowing the gap in vision health disparities.

A number of states have adopted certification programs for community health workers (CHWs) to increase oversight, allow for direct funding, and improve recognition of CHWs as members of the health care team. More states are considering CHW certification programs to increase the use of CHWs by health care organizations with the hopes of improving health outcomes and decreasing health disparities. There has been little research into the impact of state CHW certification on the adoption and dissemination of CHWs into the existing health care system. This study examined the impact of state CHW certification on the perceptions of team climate among registered nurses (RNs) who work with CHWs in states with and without CHW certification programs. Team climate is defined as the perceptions of team members on how they work together, share a single vision, are open to new ideas, and if they feel safe and supported by other team members. This study recruited RNs using an online purposeful sampling method to compare the perceptions of team climate using the Team Climate Inventory (TCI) short-form. The study found no significant differences in the overall mean TCI score or TCI subscale scores between RNs who work in states with CHW certification programs (n = 81) and those who work in states without CHW certification programs (n = 115). There was a significant difference in one survey question on the RNs views of whether state certification of CHW improved the ability of their health care team to deliver quality care. Further analysis of the results using multiple regression found few significant predictors of overall TCI and TCI subscale scores among the independent variables used in the regression models. Registered nurses are the largest part of the professional health care workforce, and their ability to collaborate and work with CHWs is critical to the integration of CHWs into existing health care organizations. More research on the impact of state certification of CHW and the factors that influence the adoption of innovative health care delivery methods is needed to meet the national goal of eliminating health disparities and improving health in minority and underserved populations.

This study examined the relationship between acculturation and obesity in foreign-born Asians residing in the United States. Two proxies were used to measure level of acculturation: years of United States residency and English language use and proficiency. Hypothesis 1 predicted that acculturation measured as number of years of residence will positively predict obesity. Hypothesis 2 predicted that acculturation measured as English language preference and proficiency will positively predict obesity.

The study used data from the 2009 California Health Interview Survey. Study participants met two inclusion criteria: foreign born and Asian. Point Biserial was run to determine whether or not there was a correlation.

Results showed a weak relationship between obesity and both variable used to measure acculturation. Additional exploratory analysis was performed to determine whether or not there was a relationship between obesity and acculturation for each Asian ethnicity. Results of this exploratory analysis were mixed.

A variety of paint products are used for their aesthetic and anti-corrosive properties. Isocyanates are consistently found in automobile paint products, particularly in clear coat polyurethane products. Clear coat is typically sprayed via pressurized air by means of an auto-spray robot. In clear coat repair situations, manual, air-powered spray guns are used, and manual spray Operators administer the clear coat material. The isocyanates are a primary anti-corrosive agent in polyurethane products. The Occupational Safety and Health Administration (OSHA) has not established a Permissible Exposure Limit (PEL). The National Institute for Occupational Safety and Health (NIOSH) and American Conference of Governmental Industrial Hygienists (ACGIH) have set Recommended Exposure Limit (REL) and Threshold Limit Value (TLV), respectively. NIOSH recommends a 0.005 parts per million (ppm), 10-hour Time Weighted Average (TWA), and a ceiling exposure of 0.020 ppm in a 10 minute period. Similarly, ACGIH recommends a 0.005 ppm, 8 hour TWA.

Automobile manufacturers use clear coats in a variety of ways. Some may use clear coats with blocked isocyanates, or isocyanates that are completely reacted, and others may use clear coat products that allow isocyanates to be liberated during an application, baking, and curing process. The research objective of this study was to characterize exposure, focusing on a single manufacturer’s use of isocyanate-containing clear coats in their Paint Department. A newly evaluated medium (ISO 17734) using di-n-butylamine as a derivative agent, in a denuder tube, was selected instead of NIOSH methods 5521, 5522, and 5525. The ISO evaluated medium was selected to reduce secondary hazard exposure to toluene in impingers. Second, a medium developed by SKC, Inc., called ISO-CHEK®, was not selected because of the short collection time, sensitivity of the medium after collection, and storage and shipping requirements for analysis.

Sampling took place over two days, one day for manual spray operations with 2 personal samples from Operators, and 4 area samples collected, and the second day for auto-sprayer Inspectors with 4 personal samples collected. The samples were then analyzed for hexamethylene diisocyanates (HDI) monomer and homopolymer species. The 0.005 ppm, 10 hour TWA; the 0.020 ppm ceiling limit (10 minutes); and the 0.005 ppm 8-hour TWA TLV were not exceeded on either day of sampling. Neither the area nor the personal samples exceeded the 10 hour TWA, ceiling limit, or TLV. In fact, the results had to be recalculated in to parts per billion (ppb). The average exposure for manual spray Operators was 0.052 ppb for the homopolymer, and 0.024 ppb for the monomer species. For auto-spray Inspectors, the average was 0.053 ppb for the homopolymer component and 0.021 ppb for the monomer species. Though the average isocyanate concentration was similar for both Operators and Inspectors, the averages are still below REL and TLV recommendations. These data provided preliminary information regarding the exposure to isocyanates from clear coat use, and also provide context for future evaluation of isocyanate use at this automobile manufacturer. The low concentration of isocyanates could indicate working ventilation systems, liberation of isocyanate species to non-hazardous forms, or low volatilization of isocyanates from the clear coat.

Introduction: Analyzing trends in breast cancer mortality can ensure a precise characterization of changes over time and can be important in public health decision making. Most reported trends are limited to incidence and mortality rates among Whites and Blacks, without categorization regarding tumor clinical characteristics. This study analyzed breast cancer mortality trends among different race-ethnic groups using various approaches such as partitioning rates by factors associated at the time of diagnosis; taking into consideration age, cohort and period effects; and by evaluating geographical variations.

Methods: Incidence and mortality data from 1990 to 2012 of female invasive breast cancer among women aged 18-84 years in United States (U.S.) was provided by the National Cancer Institute. The following analyses were conducted: (1) calculation of incidence based mortality (IBM) rates by estrogen receptor (ER) status according to race-ethnicity; (2) examination of temporal trends using age-period-cohort (APC) analysis on incidence and mortality rates; and, (3) spatiotemporal analysis of the county level age-standardized breast cancer mortality rates to identify significant geographical areas with higher risk.

Results: IBM rates for ER+ tumors increased while those of ER- tumors decreased among all race-ethnic groups. APC analysis showed that race-ethnic disparities were largely among the ER- tumors and temporal trends of the ER+ tumors were similar across the race-ethnic groups, with identical effects across the various birth cohorts. Geographical variation in the breast cancer county-level mortality rate was mostly explained by age-standardization and county level risk factors, although the effect of these factors was greater in rural areas of western U.S.

Conclusion: Temporal trends in the IBM rates were more reflective of the recent changes in the incidence trends of female invasive breast cancer. Trends of ER+ tumors were similar across all race-ethnic groups suggesting a common risk factor for the persistent increase in the incidence and mortality of these tumors. Spatial analysis shows that the higher mortality risk in certain rural counties of western U.S. might be due to poor survival than an elevated incidence and the need for better health care access in these medically underserved areas. These results might explain the observed ethnic and geographic variations in breast cancer mortality, and in turn, could support a stronger theoretical basis for public health policy.