Does Distance Matter? Distance to Mammography Facilities and Stage at Diagnosis of Breast Cancer in Kentucky

ABSTRACT:  Background: National and regional data indicate that breast cancer early detection is low in Kentucky, especially rural regions, perhaps because access to mammography services can be problematic. Objective: This study examined the distance between residences of women diagnosed with breast cancer and the nearest mammography facility, as a risk factor for advanced stage diagnosis in rural populations. Methods: 1999-2003 Kentucky Cancer Registry data were used for this study. A total of 12,322 women, aged 40 and older at diagnosis, with no previous history of cancer, and with known cancer stage were included. Travel distance was obtained using a geographic information system (GIS). Hierarchical logistic regression models were used to analyze the relationship between travel distance and advanced stage diagnosis. Results: Advanced diagnoses had longer average travel distances than early stage diagnoses (P < 0.01). After adjusting for age, race, insurance, and education at census tract level, the odds of advanced diagnosis were significantly greater for women residing over 15 miles from a facility, compared to those living within 5 miles (adjusted OR = 1.50, 95% CI = 1.25-1.80). Conclusion: Although socioeconomic status, race, and age may help explain advanced diagnoses, longer travel distance also adversely affects early detection for rural populations. Accurate measurement of spatial accessibility indicators, such as travel distance, facilitates identification of at-risk groups so that interventions can be developed to reduce this disease.     

Disparities in Adolescent Health and Health Care: Does Socioeconomic Status Matter?

DATA COLLECTION/EXTRACTION METHODS: National household survey. DATA SOURCES/STUDY SETTING: We analyzed data on 12,434 adolescents (10 through 18 years old) included in the 1999 and 2000 editions of the National Health Interview Survey. STUDY DESIGN: We assessed the presence of income gradients using four income groups. Outcome variables included health status, health insurance coverage, access to and satisfaction with care, utilization, and unmet health needs. PRINCIPAL FINDINGS: After adjustment for confounding variables using multivariate analysis, statistically significant disparities were found between poor adolescents and their counterparts in middle- and higher-income families for three of four health status measures, six of eight measures of access to and satisfaction with care, and for six of nine indicators of access to and use of medical care, dental care, and mental health care. CONCLUSION: Our analyses indicate adolescents in low-income families remain at a disadvantage despite expansions of the Medicaid program and the comparatively new State Children's Health Insurance Program (SCHIP). Additional efforts are needed to ensure eligible adolescents are enrolled in these programs. Nonfinancial barriers to care must also be addressed to reduce inequities.     

Do Adolescent Sexual and Reproductive Attitudes and Knowledge Predict Men and Women's Adult Sexual Partnerships?

PurposeAdolescence is a key stage for forming knowledge and attitudes about sex and reproduction that may have long-term implications for adult sexual behaviors. Gender differences in experiences and socialization processes may affect the links between adolescent characteristics and adult behaviors.MethodsBy following adolescent virgins aged 15 years and older from wave I through wave IV of the National Longitudinal Study of Adolescent to Adult Health (n = 4,152), we test whether adolescent boys' and girls' knowledge about, and attitudes toward, sex and reproduction influence the number of lifetime different-sex sexual partners and the likelihood of having concurrent sexual partners in adulthood, using negative binomial regression and logistic regression, respectively. Models are run separately by gender.ResultsMen and women who reported greater physical benefits of sex as adolescents reported more lifetime different-sex sexual partners and were more likely to have concurrent sexual partners in adulthood. For women, adolescent perceptions of more social costs to sex were linked to fewer lifetime sexual partners, whereas greater birth control confidence was linked to more sexual partners. Women who more strongly felt that avoiding sexually transmitted infections was a hassle during adolescence were less likely to have concurrent sexual partners as adults, and men who were more knowledgeable about condoms during adolescence were more likely to have concurrent sexual partners.ConclusionsAdolescent knowledge and attitudes about sex, contraception, and reproduction have implications for adult sexual behavior, but different aspects emerge as salient for men and women.     

How Much Does Gender Explain in Sexual Attitudes and Behaviors? A Survey of Canadian Adults

While it is common for gender to be included as a predictor variable in studies of sexuality, this is not the case for other demographic variables. This study examined the predictive value of gender, along with other demographic variables, including age, marital status, education, religiosity, and geographic region using data from a national survey of Canadian adults over the age of 18 (N = 1479). The survey was conducted by the COMPAS survey organization using computer assisted telephone technology. The outcome variables examined included frequency of sexual thoughts, oral sex, age at first intercourse, number of sexual partners, and casual sex intentions. For each of the variables, men were more sexually permissive and more sexually active than were women. Other demographic variables increased the explanatory power of the models but gender still remained a significant predictor of sexual attitudes and behaviors despite statistical control for other demographic variables. The findings demonstrate the influence of gender on sexuality but also illustrate the value of taking into account other demographic variables when analyzing gender differences in sexuality.     

Access to Money and Relation to Women’s Use of Family Planning Methods Among Young Married Women in Rural India

Objectives The social positioning (i.e. social status and autonomy) of women in the household facilitates women’s access to and decision-making power related to family planning (FP). Women’s access to spending money, which may be an indicator of greater social positioning in the household, may also be greater among women who engage in income generating activities for their families, regardless of women’s status in the household. However, in both scenarios, access to money may independently afford greater opportunity to obtain family planning services among women. This study seeks to assess whether access to money is associated with FP outcomes independently of women’s social positioning in their households. Methods Using survey data from married couples in rural Maharashtra, India (n = 855), crude and adjusted regression was used to assess women’s access to their own spending money in relation to past 3 month use of condoms and other forms of contraceptives (pills, injectables, intrauterine device). Results Access to money (59 %) was associated with condom and other contraceptive use (AORs ranged 1.5–1.8). These findings remained significant after adjusting for women’s FP decision-making power in the household and mobility to seek FP services. Conclusion While preliminary, findings suggest that access to money may increase women’s ability to obtain FP methods, even in contexts where social norms to support women’s power in FP decision-making may not be readily adopted.     

Advance Care Planning Engagement and End-of-life Preference Among Older Chinese Americans: Do Family Relationships and Immigrant Status Matter?

ObjectivesTo examine how immigrant status and family relationships are associated with advance care planning (ACP) engagement and end-of-life (EOL) preference in burial planning among older Chinese Americans, the largest subgroup of Asian Americans.DesignCross-sectional survey.SettingCommunities in Honolulu, Hawai'i.ParticipantsParticipants were 430 older Chinese Americans aged 55 years and older.MeasuresMeasures included ACP contemplation, ACP discussion, and EOL preference in burial planning, immigrant status, family cohesion, family conflict, demographic information, and health status.ResultsResults show that in comparison to foreign-born Chinese Americans, US-born Chinese Americans were more likely to have ACP contemplation [odds ratio (OR) 2.80, 95% confidence interval (CI) 1.39-5.63], ACP discussion (OR 3.02, 95% CI 1.50-6.08), and preferences for burial plans at the end of life (OR 4.56, 95% CI 2.04-10.18). Family conflict increased the possibility of having ACP contemplation (OR 1.21, 95% CI 1.07-1.38), ACP discussion (OR 1.22, 95% CI 1.07-1.39), and EOL preference in burial planning (OR 1.22, 95% CI 1.04-1.42), whereas family cohesion was not associated with these study outcomes.Conclusions and ImplicationsThis study suggests that ACP should be adapted to be more culturally appropriate, especially in a time of coronavirus and xenophobia, such as framing ACP as a tool to help families reduce stress while fulfilling filial obligations, in order to ensure equitable access to ACP.     

Trajectories of Violent and Nonviolent Behaviors From Adolescence to Early Adulthood: Does Early Puberty Matter,and, If So,How Long?

PurposeIt is well known that pubertal timing affects adolescents' externalizing behaviors, but it is unknown if this effect lasts into adulthood. This study assessed if and when the early maturation effect wanes, specifically in two domains of externalizing behaviors: nonviolent and violent behaviors.MethodsUsing data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) that include age-appropriate items of violent and nonviolent behaviors assessed from ages 11–30 over four waves (N = 4,255), we conducted a series of longitudinal growth curve analyses to evaluate the effect of pubertal timing on the trajectories of nonviolent and violent externalizing behaviors for males and females.ResultsCompared to later maturing male peers, early maturing males reported significantly elevated overall externalizing, nonviolent, and violent behaviors throughout adolescence, but became indistinguishable from on-time and late-maturing counterparts in young adulthood. Similarly, early maturing females showed higher levels of overall externalizing and nonviolent behaviors than later maturing counterparts, but no effect of pubertal timing was seen on the trajectories of violent behaviors. However, early maturing females' overall externalizing and nonviolent behaviors also became indistinguishable from on-time and late-maturing females after adolescence.ConclusionsThese findings clarify the differential effect of early maturation on nonviolent and violent behaviors, especially in females, and highlight the short-lived nature of the effects of early pubertal timing.     

Does Alcohol Outlet Density Affect Youth Access to Alcohol?

PurposeTo investigate how community alcohol outlet density may be associated with alcohol access among adolescents.MethodsData were collected through a three-wave panel study with youth aged 14–16 at baseline using computer-assisted telephone interviews. Study participants were recruited from 50 zip codes with varying alcohol outlet density and median household income in California. Data analyses were conducted using multilevel, linear growth models and data from 1028 youth (52% male, 51% white).ResultsAfter taking into account individual-level factors and zip code median household income, zip code alcohol outlet density was significantly and positively related to the initial levels of the likelihood and frequency of getting alcohol through various sources including commercial outlets, shoulder tapping, home or family members, and underage acquaintances.ConclusionsHigh levels of alcohol outlets in the community enable youth access to alcohol through commercial outlets, family, and social networks.     

Food Composition Databases: Does It Matter to Human Health?

Food provides humans with more than just energy and nutrients, addressing both vital needs and pleasure. Food habits are determined by a wide range of factors, from sensorial stimuli to beliefs and, once commanded by local and seasonal availability, are nowadays driven by marketing campaigns promoting unhealthy and non-sustainable foodstuffs. Top-down and bottom-up changes are transforming food systems, driven by policies on SDGs and by consumer’s concerns about environmental and health impacts. Food quality, in terms of taste, safety, and nutritional value, is determined by its composition, described in food composition databases (FDBs). FDBs are then useful resources to agronomists, food and mechanical engineers, nutritionists, marketers, and others in their efforts to address at maximum human nutrient needs. In this work, we analyse some relevant food composition databases (viz., purpose, type of data, ease of access, regularity of updates), inspecting information on the health and environmental nexus, such as food origin, production mode as well as nutritional quality. The usefulness and limitations of food databases are discussed regarding what concerns sustainable diets, the food ‘matrix effect’, missing compounds, safe processing, and in guiding innovation in foods, as well as in shaping consumers’ perceptions and food choices.     

Motivating High-Risk Older Adults to Exercise: Does Coaching Matter?

The aim of the study was to compare two coaching channels—a combination of telephone and face-to-face coaching (combined phone and face-to-face) versus telephone coaching only (phone)—on exercise performances in a home-based low-intensity program. Multiple regression models were used to examine if the two coaching channels were associated with different 3-month posttest exercise performances. Individuals with the combined phone and face-to-face coaches had better exercise performances at 3-month posttest, compared to those who received phone coaching only. The evaluation suggests that, in a home-based, low-intensity training program that has been demonstrated to benefit high-risk, ethnically diverse older adults, face-to-face coaching appears to be a more powerful motivator than a phone-based approach only.     

How Well Does Medicaid Work in Improving Access to Care?

OBJECTIVE: To provide an assessment of how well the Medicaid program is working at improving access to and use of health care for low-income mothers. DATA SOURCE/STUDY SETTING: The 1997 and 1999 National Survey of America's Families, with state and county information drawn from the Area Resource File and other sources. STUDY DESIGN: Estimate the effects of Medicaid on access and use relative to private coverage and being uninsured, using instrumental variables methods to control for selection into insurance status. DATA COLLECTION/EXTRACTION METHOD: This study combines data from 1997 and 1999 for mothers in families with incomes below 200 percent of the federal poverty level. PRINCIPAL FINDINGS: We find that Medicaid beneficiaries' access and use are significantly better than those obtained by the uninsured. Analysis that controls for insurance selection shows that the benefits of having Medicaid coverage versus being uninsured are substantially larger than what is estimated when selection is not accounted for. Our results also indicate that Medicaid beneficiaries' access and use are comparable to that of the low-income privately insured. Once insurance selection is controlled for, access and use under Medicaid is not significantly different from access and use under private insurance. Without controls for insurance selection, access and use for Medicaid beneficiaries is found to be significantly worse than for the low-income privately insured. CONCLUSIONS: Our results show that the Medicaid program improved access to care relative to uninsurance for low-income mothers, achieving access and use levels comparable to those of the privately insured. Our results also indicate that prior research, which generally has not controlled for selection into insurance coverage, has likely understated the gains of Medicaid relative to uninsurance and overstated the gains of private coverage relative to Medicaid.     

Family Consumer Behaviors,Adolescent Prediabetes and Diabetes in the National Health and Nutrition Examination Survey (2007–2010)

Background: Prediabetes or diabetes (characterized by hemoglobin A1c [HbA1c] levels ≥ 5.7 gm%) has been associated with numerous long-term complications. Family consumer behaviors are important risk factors that lead to impaired glucose tolerance or diabetes. However, few studies have studied the association between the family consumer environment and prediabetes and diabetes in adolescents.

Objective: The aim of this study was to examine the association between family consumer behaviors (healthy food availability and supermarket spending) and adolescent prediabetes and diabetes (ClinicalTrials.gov identifier #NCT03136289.)

Methods: Data from a nationwide survey conducted by the Centers for Disease Control and Prevention (National Health and Nutrition Examination Survey [NHANES] 2007–2010 data) were used for these analyses. Adolescents aged 12–19 years were selected for this study. Bivariate analyses and logistic regression models assessed the relationship between family consumer behaviors and the prevalence of adolescent prediabetes and diabetes. Multivariable models adjusted for age, gender, ethnicity, physical activity, education, income, and household size.

Results: A total of 2520 adolescents were eligible for this study. Adolescents with healthier household food availability had negative odds (odds ratio [OR] = 0.74, 95% confidence interval [CI], 0.55–1.00), as did higher log supermarket spending (OR = 0.69; 95% CI, 0.57–0.85). Interaction models demonstrated that adolescent females had more negative odds of prediabetes/diabetes for both healthier food availability (OR = 0.79, 95% CI, 0.39–1.29) and for greater log supermarket spending (OR = 0.69, 95% CI, 0.57–0.85).

Conclusion: This study shows that both healthy food availability and an increase in supermarket spending were associated with a decreased adjusted prevalence of prediabetes and diabetes in adolescents, with a greater effect in females. These results suggest the need for policy and dietary interventions targeting the consumer environment.     

Is Direct Access to Obstetricians/Gynecologists Effective at Improving Maternal Health Behaviors?

Objective. To examine the effects of state legislation mandating direct access to obstetricians and gynecologists (OB/GYNs) on maternal health behaviors and infant health outcomes. Data Sources. 1992–2002 Natality Detail File; 1994–2002 Pregnancy Assessment and Monitoring Survey (PRAMS). Study Design. Using variation in state policy over time, we use individual‐level data from two sources to consider the effects of direct access legislation on prenatal care utilization, maternal health behaviors during pregnancy, and infant health outcomes. Principal Findings. Our results suggest that there is little evidence that direct access laws are effective at improving prenatal care access or conferring benefits to mothers and infants. These results are consistent across two data sets, a variety of specifications, and specific subgroups of women who are most likely to be affected by direct access legislation. Conclusion. We conclude that direct access to OB/GYNs is not related to improvements in maternal health behaviors or infant health outcomes. If policy makers are interested in reforms that improve maternal and infant health, we recommend a focus on alternative policies.     

Perceptions of Adolescents’ Sexual Behavior Among Mothers Living With and Without HIV: Does Dyadic Sex Communication Matter?

Previous studies suggest that mothers can help adolescents make responsible sexual decisions by talking with them about sexual health. Yet, it is not clear how and when mothers make decisions about talking with their adolescents about sex. We sought to determine: (1) the accuracy of mothers’ and adolescents’ predictions of adolescents’ age of sexual debut; and (2) if mothers’ beliefs about their adolescents’ sexual behavior affected the frequency of mother–adolescent communication about sexual topics and, in turn, if mother–adolescent communication about sexual topics affected mothers’ accuracy in predicting adolescents’ current and future sexual behavior. Participants were 129 urban, ethnic minority HIV-negative youth (52% male and 48% female; ages 10–14 years at baseline; ages 13–19 years at follow-up) and their mothers; 47% of mothers were HIV-positive. Most mothers and adolescents predicted poorly when adolescents would sexually debut. At baseline, mothers’ communication with their early adolescents about sexual topics was not significantly associated with mothers’ assessments of their early adolescents’ future sexual behavior. At follow-up, mothers were more likely to talk with their adolescents about HIV prevention and birth control if they believed that their adolescents had sexually debuted, though these effects were attenuated by baseline levels of communication. Only one effect was found for adolescents’ gender: mothers reported greater communication about sex with daughters. Studies are needed to determine how mothers make decisions about talking with their adolescents about sex, as well as to examine to what extent and in what instances mothers can reduce their adolescents’ sexual risk behavior by providing comprehensive, developmentally appropriate sex education well before adolescents are likely to debut.     

Do U.S. Family Planning Clinics Encourage Parent‐Child Communication? Findings from an Exploratory Survey

CONTEXT: Clinics that receive Title X funding have a mandate to encourage parent-child communication for minors seeking family planning services. Little is known about the programs and practices that clinics have adopted to achieve this goal, or whether clinics not receiving Title X funds encourage family participation. METHODS: As part of a larger project examining parental engagement among adolescents using family planning clinics, 81 clinics that served 200 or more adolescent contraceptive clients in 2001 completed a questionnaire containing closed- and open-ended items. Topic areas included clinic counseling and policies regarding clients younger than 18, activities to improve parent-child communication and community relations. Frequency distributions were calculated for the prevalence of activities, and cross-tabulations were used to compare prevalence by clinic characteristics. RESULTS: Every clinic engaged in at least one activity to promote parent-child communication, and nine in 10 offered multiple activities. Most of the clinics used counseling sessions to talk to adolescent clients about the importance of discussing sexual health issues with parents (73-94%, depending on the reason for the visit). More than eight in 10 clinics (84%) distributed pamphlets on how to talk about these issues. A substantial minority (43%) offered or referred interested individuals to educational programs designed to improve communication. Some of these exploratory findings reflect the prevalence of activities among all U.S. family planning clinics that serve adolescent clients. CONCLUSIONS: Evaluation and expansion of clinic efforts to promote voluntary communication about sexual health issues between parents and children could help encourage family participation.     

Correlates of Extra-Dyadic Sex in Czech Heterosexual Couples: Does Sexual Behavior of Parents Matter?

Despite frequent sanctions and potentially serious consequences, extra-dyadic involvements are a relatively common phenomenon. Previously, potential links among extra-dyadic involvements and personal or interpersonal characteristics were extensively explored. However, the developmental aspects of extra-dyadic relationships have been rather overlooked to date. Here, we focus on the association between self-reported extra-dyadic tendencies and behavior, and previous experience with extra-dyadic sex in prior romantic relationships and in the primary family. We asked both members of 86 long-term cohabiting couples to complete several inventories assessing various aspects of the relationship satisfaction, sociosexuality and extra-dyadic intentions and behavior. As in previous studies, we found a lower level of overall Dyadic Adjustment and in the subscales Affectional Expression and Dyadic Consensus, in particular, among women but not men who reported extra-pair sex. Neither experience with own nor partners’ infidelity in previous relationships was linked to reported extra-pair sex in the current relationship. However, men who reported their fathers but not mothers being unfaithful were also significantly more often unfaithful and showed a higher level of extra-dyadic intentions. There was no association between parental infidelity and extra-pair sex or extra-dyadic intentions in women. Our results suggest that experience of infidelity within the primary family has an impact on subsequent behavior. However, this is the case only in men. Women’s extra-dyadic activities seem to be affected instead by the quality of the current relationship. Future research is needed to test the influence of ontogenetic and hereditary factors on the development of infidelity tendencies.