Correlates of underutilization of colorectal cancer screening among U.S. adults,age 50 years and older

BACKGROUND: Although effective screening for colorectal cancer (CRC) exists, only 37% of incident CRC are diagnosed at a localized stage at which treatment is effective. We identified demographic and other characteristics of adults (> or = 50 years old) who reported no CRC screening. METHODS: We calculated the prevalence of never having had a fecal occult blood test and/or a sigmoidoscopy or colonoscopy by age, sex, and other factors using the 1999 Behavioral Risk Factor Surveillance System data. RESULTS: CRC screening tests were underutilized across all segments of the population. Underutilization was highest in persons aged 50-64 years and those with lower education and a lack of health insurance and preventive services. CONCLUSIONS: The data indicate that large proportions of average-risk adults across various sociodemographics and behavioral factors are not utilizing recommended CRC screening tests. There is a need to increase the awareness of the importance of utilizing effective CRC screening tests for the early detection of colorectal cancers.     

上海市区1973至2005年癌症的发病趋势

目的了解企业职业人群的大肠癌筛查行为及相关因素,为提高职业人群大肠癌筛查参与率提出相应干预策略。方法于2016年采用自行设计的问卷,对上海市黄浦区某企业203名40~60岁职业人群的大肠癌筛查行为及其相关因素进行横断面调查。使用单因素和二元非条件logistic回归模型进行统计学分析。结果职业人群便隐血检测（FOBT）参与率为8.4%,直肠指检参与率为50.2%。多因素分析显示,文化程度较高（OR=4.27,95%CI为2.13~8.56）、正常体重及低体重（BMI < 24）（OR=1.93,95%CI为1.03~3.62）、大肠癌知识水平较高（OR=3.27,95%CI为1.76~6.09）是促使职业人群进行直肠指检的相关因素。结论职业人群FOBT、直肠指检参与率较低,企业应针对重点人群开展职工健康教育和促进活动,进一步提高大肠癌筛查的参与率。     

Attempting to lose weight: specific practices among U.S. adults

BACKGROUND: Americans spend over $33 billion annually on weight-loss products and services. Although weight-control methods are of considerable public health interest, few national data on weight-loss practices are available. This paper examines the prevalence of specific weight-loss practices among U.S. adults trying to lose weight. METHODS: Data from the 1998 National Health Interview Survey, which was conducted through face-to-face interviews of a nationally representative sample of U.S. adults (n =32,440), were analyzed in 2003. RESULTS: Twenty-four percent of men and 38% of women were trying to lose weight. Attempting weight loss was less common among normal weight (body mass index [BMI]<25 kg/m(2)) people (6% men, 24% women) than overweight (BMI>/=25 to 30 kg/m(2)) people (28%, 49%) or obese (BMI>/=30 kg/m(2)) people (50%, 58%). Among those trying to lose weight, the most common strategies were eating fewer calories (58% men, 63% women); eating less fat (49%, 56%); and exercising more (54%, 52%). Less frequent strategies were skipping meals (11% men, 9% women); eating food supplements (5%, 6%); joining a weight-loss program (3%, 5%); taking diet pills (2%, 3%); taking water pills or diuretics (1%, 2%); or fasting for >/=24 hours (0.6%, 0.7%). Only one third of all those trying to lose weight reported eating fewer calories and exercising more. CONCLUSIONS: Increased efforts are needed among all those trying to lose weight to promote effective strategies for weight loss, including the use of calorie reduction and increased physical activity.     

Body mass index and death rate of colorectal cancer among a national cohort of U.S. adults

Substantial evidence suggests that increasing adiposity is associated with an increased death rate of colorectal cancer, but no studies were conducted among national representative populations in the United States. The current study examined the death rate across BMI levels in 7,016 adults who participated in the National Health and Nutrition Examination Survey in 1971-1975. BMI categories were defined as normal (18.5-24.9 kg/m(2)), overweight (25-29.9), and obese (≥30). A total of 519 cancer deaths were identified during a 17-yr follow-up with 118,998 person-years. No significantly increased death rates of total cancers, lung, breast, and prostate cancer were observed among participants with an increased BMI. However, colorectal cancer death rates were 0.39, 0.68, and 0.96/1,000 person-years, respectively, for normal weight, overweight, and obese (P value for log-rank trend test < 0.001), and the corresponding adjusted hazard ratios [95% confidence intervals (CI)] were 1.00 (reference), 1.25 (95% CI = 0.72-2.19), and 2.04 (1.08-3.83), respectively. No gender difference of the association was identified. The authors conclude that a significantly increased death rate of colorectal cancer was associated with excess body weight. The current study is an addition to the expanding body of literature indicating an increased risk of colorectal cancer development among the obese.     

Total body skin examination for skin cancer screening among U.S. adults from 2000 to 2010

ObjectiveMelanoma incidence and mortality are increasing among United States adults. At present, routine skin cancer screening via total body skin examinations (TBSEs) by a physician is not recommended by the United States Preventive Services Task Force (USPSTF); while organizations such as the American Cancer Society recommend screening. Currently, there are limited data on the prevalence, correlates, and trends of TBSE among United States adults.MethodsWe analyzed data by race/ethnicity, age, and skin cancer risk level, among other characteristics from three different National Health Interview Survey (NHIS) cancer control supplements conducted every five years since 2000 in random United States households. High-risk status and middle-risk status were defined based on the USPSTF criteria (age, race, sunburn, and family history).ResultsPrevalence of having at least one TBSE increased from 14.5 in 2000 to 16.5 in 2005 to 19.8 in 2010 (P < 0.0001). In 2010, screening rates were higher among the elderly, the fair-skinned, those reporting sunburn(s), and individuals with a family history of skin cancer. Approximately 104.7 million (51.1%) U.S. adults are at high-risk for developing melanoma, of which 24.0% had at least one TBSE.ConclusionsTBSE rates have been increasing since 2000 both overall and among higher-risk groups. Data on screening trends could help tailor future prevention strategies.     

Skin cancer screening among U.S. adults from 1992, 1998, and 2000 National Health Interview Surveys

BACKGROUND: Relatively little is known about the prevalence of skin cancer screening in the context of inconsistent skin cancer screening recommendations. METHODS: To determine the prevalence and predictors of skin cancer screening rates in the U.S. adult population, we used self-reported data from the 1992, 1998, and 2000 National Health Interview Surveys, a nationally representative survey of civilian noninstitutionalized adults. RESULTS: The percentage of the U.S. adult population who had ever had a skin examination conducted by a doctor was 20.6% in 1992, 20.9% in 1998, and 14.5% in 2000. The percentage with a recent skin examination was 10.3% in 1992, 11.0% in 1998, and 8.0% in 2000. White non-Hispanics reported being screened more frequently than persons in other racial or ethnic groups. Recent skin cancer screening exams were more common among white persons who had a family history of melanoma, had higher education, had usual place of care, and were older (> or =50 years). Frequent use of sunscreen and hats was associated with a recent skin cancer exam. CONCLUSIONS: In the past decade, skin cancer screening rates have been consistently low. Continued monitoring of skin cancer examination is important given conflicting current research results and potentially evolving science.     

Trends in waist circumference among U.S. adults

OBJECTIVE: Waist circumference has been proposed as a measure of obesity or as an adjunct to other anthropometric measures to determine obesity. Our objective was to examine temporal trends in waist circumference among adults in the U.S. RESEARCH METHODS AND PROCEDURES: We used data from 15,454 participants >/=20 years old in National Health and Nutrition Examination Survey (NHANES) III (1988 to 1994) and 4024 participants >/=20 years old from National Health and Nutrition Examination Survey 1999 to 2000. RESULTS: The unadjusted waist circumference increased from 95.3 (age-adjusted, 96.0 cm) to 98.6 (age-adjusted, 98.9 cm) cm among men and from 88.7 (age-adjusted 88.9 cm) to 92.2 (age-adjusted 92.1 cm) cm among women. The percentiles from the two surveys suggest that much of the waist circumference distribution has shifted. Statistically significant increases occurred among all age groups and racial or ethnic groups except men 30 to 59 years old, women 40 to 59 and >/=70 years old, and women who were Mexican American or of "other" race or ethnicity. DISCUSSION: These results demonstrate the rapid increase in obesity, especially abdominal obesity, among U.S. adults. Unless measures are taken to slow the increase in or reverse the course of the obesity epidemic, the burden of obesity-associated morbidity and mortality in the U.S. can be expected to increase substantially in future years.     

Family history of cancer and utilization of prostate, colorectal and skin cancer screening tests in U.S. men

BACKGROUND: For cancers related to genetic factors, screening may be particularly important for individuals who have a family history of the disease. This study examined whether men with a family history of cancer were more likely to utilize prostate, colorectal or skin cancer screenings compared to those without a family history. METHODS: The data for this study came from male respondents who participated in the 2000 National Health Interview Survey. The age range of the study subjects and the definitions of cancer screening were determined based on the American Cancer Society recommendations on cancer screening. RESULTS: Men who had a family history of colorectal cancer were twice more likely to utilize colorectal cancer screening than men without a family history of the disease. Compared to men without a family history of prostate cancer, men with a family history were more likely to undergo a PSA examination. The association of family history with colorectal and prostate cancer screening was stronger among younger men. CONCLUSIONS: Family history of cancer was highly associated with colorectal and prostate cancer screening examinations in U.S. men. This may reflect more physicians' recommendations and a higher motivation to get a screening test for men with a family history of cancer.     

The relationship between obesity and injuries among U.S. adults

PURPOSE: To quantify the relationship between body mass index (BMI) and rates of medically attended injuries by mechanism (overall, fall, motor vehicle, and sport-related) and by nature (strain/sprain, lower extremity fracture, and dislocations), and between BMI and injury treatment costs. DESIGN: Cross-sectional analysis. SETTING. The noninstitutionalized population of the United States. SUBJECTS: The 1999-2000, 2000-2001, and 2001-2002 waves of the Medical Expenditure Panel Survey, a large, nationally representative dataset, were combined to create the analysis sample. The final sample included 42,304 adults. MEASURES. Medically attended injury rates by mechanism and nature of injury and related treatment costs. ANALYSIS: Logistic regressions were used to separately estimate the odds of sustaining any injury by mechanism or by nature for overweight (25 < BMI : 29.9) and three categories of obese individuals compared with those who were normal weight. A second set of regressions tested whether, given that an injury occurred, obese individuals had greater injury treatment costs. RESULTS. Slightly more than one in five adults sustain an injury each year that requires medical treatment. The odds of sustaining an injury are 15% (overweight) to 48% (Class III obesity) greater among those with excess weight. Conditional on sustaining an injury, BMI did not have a significant impact on injury treatment costs. CONCLUSION: Our findings show a clear association between BMI and the probability of sustaining an injury. If increasing BMI is causing the rise in injury rates, then the incidence of injuries, including those related to falls, sprains/strains, lower extremity fractures, and joint dislocations, are likely to increase as the prevalence of obesity increases.     

Patient numeracy, perceptions of provider communication, and colorectal cancer screening utilization

Patients with poor numeracy skills may have difficulty participating in shared-decision making, affecting their utilization of colorectal cancer (CRC) screening. We explored the relationship between numeracy, provider communication, and CRC screening. Data were from the 2007 National Cancer Institute Health Information Trends Survey. Individuals age 50 years or older responded via mail or phone to items measuring numeracy, perceptions of provider communication quality, and CRC screening. After accounting for national sampling weights, multivariate logistic regression models examined the association between these factors. A total of 1,436 subjects responded to an objective numeracy item via mail, and 3,286 responded to a subjective numeracy item via mail or phone; 22.6% had low objective numeracy, and 39.4% had low subjective numeracy. Low subjective numeracy was associated with a lower likelihood of perceiving high quality provider communication (OR 0.63-0.73), but for low objective numeracy, the opposite was observed (OR 1.51-1.64). Low objective or subjective numeracy was associated with less CRC screening. There was significant interaction between subjective numeracy, perceptions of provider communication, and CRC screening. Patient numeracy is associated with perceptions of provider communication quality. For individuals with low subjective numeracy, perceiving high quality communication offset the association between low numeracy and underutilization of CRC screening.     

Prevalence and correlates of depressive symptoms among older U.S. adults

Using data from telephone interviews conducted during 1985, we investigated the prevalence and correlates of depressive symptoms in a national probability sample of 1,232 noninstitutionalized U.S. residents 65 years of age and older. The association between depressive symptoms and personal attributes, personal resources, illness behavior, life events, and self-reported health was examined through chi-square and logistic regression analyses. We measured depressive symptoms with the Center for Epidemiologic Studies--Depression (CES-D) scale using a score of 16 or greater as an indication of high depressive symptoms. Prevalence of high depressive symptoms was 9.9% in the total sample. For black males the prevalence of depressive symptoms was 7.4%, and for white males it was 6.8%. For black females the prevalence of depressive symptoms was 20.8%, while for white females it was 11.5%. In the regression analysis, female gender, single marital status, poor self-reported assessment of health, illness behavior, and a low number of club/organization memberships were significantly associated with high depressive symptoms. In comparison to respondents reporting good to excellent health, those reporting poor to fair health were almost four times more likely to report a high number of depressive symptoms (odds ratio = 3.97).     

Metabolic syndrome and health-related quality of life among U.S. adults

PURPOSE: Little is known about the association between health-related quality of life and the metabolic syndrome. The objective of this study was to compare health-related quality of life in adults with and without the metabolic syndrome. METHODS: We performed a cross-sectional analysis of 1859 men and women aged > or =20 years from the National Health and Nutrition Examination Survey 2001-2002. Health-related quality of life was assessed with the Centers for Disease Control and Prevention HRQOL-4 tool. RESULTS: A larger percentage of participants with the metabolic syndrome had fair or poor health (difference = 11.3%, p = 0.002), > or =14 physically unhealthy days (difference = 5.0%) (p = 0.129), > or =14 mentally unhealthy days (difference = 7.4%) (p = 0.010), and > or =14 activity-limitation days (difference = 5.8%) (p = 0.024) during the past 30 days than participants without the metabolic syndrome. After adjusting for age, sex, ethnicity, educational status, and smoking status, participants with the metabolic syndrome were more likely to have fair or poor health (odds ratio [OR], 1.94; 95% confidence interval [CI], 1.21-3.13), > or =14 mentally unhealthy days (OR, 1.97; 95% CI, 1.28-3.02), and > or =14 activity limitation days (OR, 3.20; 95% CI, 1.46-7.02) than those without the metabolic syndrome. CONCLUSIONS: U.S. adults with the metabolic syndrome experience worse health-related quality of life than adults without this syndrome.