Abstract
Watching your back: How much do people at increased risk actually know about the human papillomavirus (HPV) and its association with anal cancer?
Musarrat Rahman, MPH1 and David A. Moskowitz, PhD2
(1)New York Medical College, Valhalla, NY, (2)Northwestern University Feinberg School of Medicine, Chicago, IL
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
Background: HPV is the most common STI in the world and responsible for 5% of worldwide cancers, including anal cancer. Older women with a history of abnormal Pap smears and those engaging in receptive anal intercourse are at highest-risk for anal cancer.
Methods: An online cross-sectional survey posted to listservs and social media (Facebook, Reddit, Craigslist) assessed HPV/anal cancer knowledge, attitudes and sexual history in participants assigned female-at-birth or who currently identify as women. Participants included 345 ciswomen, 51 transwomen, and 39 transmen (N=435).
Results: About 40 participants (9.2%) reportedly had genital warts or asymptomatic HPV. About 52% received at least one dose of the HPV vaccine; transwomen were least likely to report vaccination (11.8%). About 11% of ciswomen, 18% of transmen and 6% of transwomen never heard of anal cancer until taking the survey. Most that had heard (>50% of each gender) reportedly could not pinpoint when in their life they learned about anal cancer; the internet was their primary source of education about anal cancer. Ciswomen better understood factors, signs and symptoms that increase anal cancer risks relative to transgender participants (p=.05), and reported better knowledge about HPV relative to transgender participants (p<.01). About 4.1% of ciswomen, 5.1% of transmen and 4.0% of transwomen had anal Pap smears. About 27.5% of ciswomen and 10.3% of transmen reported abnormal cervical results.
Conclusions: There is low awareness of HPV/anal cancer among all participants, particularly transgender participants. Future interventions should target knowledge gaps and emphasizing the importance of vaccination and screening.
Public health or related research
Abstract
Use of telephone reminders to increase colorectal cancer screening rates in the New York State Medicaid managed care population
Liza Powell, BA1, Victoria Wagner, MS2, Courtney Matatia, MPH2, Margaret Gates, ScD3, Elisè Collins, BA4, Sharon Bisner, RN, FNP3, Kevin Malloy, MPH2, Jacqueline Matson, MBA5 and Heather Dacus, DO, MPH3
(1)State University of New York at Albany, Rensselaer, NY, (2)New York State Department of Health, Albany, NY, (3)NYSDOH, Albany, NY, (4)NYSDOH, Menands, NY, (5)New York State Department of Health, Office of Quality and Patient Safety, Albany, NY
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
The US Preventive Services Task Force awarded colorectal cancer (CRC) screening an “A” grade, reflecting high certainty that the benefit is substantial. However, CRC screening rates in New York's Medicaid managed care (MMC) population trail the commercially insured (61% vs 63% respectively in 2015). To address this disparity, the Department of Health implemented a project to promote screening among MMC enrollees. As part of this project, the effectiveness of telephone reminders was evaluated. Two weeks after postal reminders were sent, up to three attempts were made to reach a sub-set of MMC enrollees telephonically. Enrollees were read an educational message, and asked if they: received the postal reminder; intended to be screened; and, had questions. Chi-square tests were conducted. Among 6,981 enrollees sent postal reminders, 2,740 had valid telephone numbers, 298 were called, and 149 reached. Of those reached, the majority remembered receiving the postal reminder (n=115, 77.2%) and intended to be screened (n=104, 69.8%). Poorer MMC enrollees (those receiving cash assistance) were significantly more likely to remember the postal reminder (p=0.008). Common themes among qualitative information volunteered by enrollees included an interest in completing at home screening (n=31), a perceived lack of access to health care (n=8), and a medical history involving CRC (n=8). Our findings suggest that future CRC promotion activities should promote the availability of at-home screening tests. Subsequent studies will be required to verify if these encouraging results about intention to screen after postal and telephone reminders translate into a reduced disparity in CRC screening rates.
Administer health education strategies, interventions and programs Chronic disease management and prevention Communication and informatics Conduct evaluation related to programs, research, and other areas of practice Epidemiology Implementation of health education strategies, interventions and programs
Abstract
Continuity of care in the management of the psychiatry patient: An assessment of post discharge care support for in-patient psychiatry facilities in the US
Olusegun Popoola, MD, MPH1, Odunayo Olorunfemi, MD, MPH2, Mojisola Popoola, MPH1 and Ayorinde Soipe, MD, MSc3
(1)UTHealth School of Public Health, Houston, TX, (2)Jacobi Medical Center, Bronx, NY, (3)Brown University School of Public Health, Providence, RI
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
Introduction: The post-discharge management of psychiatric patients is an important component of the comprehensive psychiatric care. These has not been assessed in recent literature. This study describes the performance of facilities in creating and transmitting discharge plans and the factors that affects them.
Methods: Two of the recently re-endorsed six performance data measures of the Hospital-Based Inpatient Psychiatric Services HBIPS (measures assessing the creation of a post-discharge continuing care plan, and the transmission of the post-discharge continuing care plan to the next level of care provider upon discharge) for 1,545 in-patient psychiatry care facilities were analyzed using chi-square tests and regression model.
Results: The mean percentage of patients across all sites who had a discharge plan created was 76.0% (N=1429, SE =0.85, S.D.=32.16), while the mean percentage of patients across all sites who had their post-discharge continuing care plans transmitted to the next level provider upon discharged from facility was 66.0% (N=1368, S.E 0.95, SD 35.0). Facilities in the South are more likely to have poorer performance for both measures tested. Multivariate analysis shows lower overall numbers of patients in a facility predicts both a higher rate of treatment plan creation (N=1418, B=-0.043, t=-15.715, p=<0.001), and plan transmission to the next care provider (N=1358, B=-.044, t =-15.512, p<0.001).
Conclusion: While there are other factors that may contribute to this, which are not examined in detail, the burden of patient load on the facilities appears to affect the performance of in-patient facilities in creating and transferring treatment care plans post-discharge.
Administration, management, leadership Chronic disease management and prevention Provision of health care to the public Public health or related education Public health or related research
Abstract
Perspectives on a Quality Abortion Care Experience: A Patient-Centered Approach
Rachel Mnuk, BS, MPH Candidate, Mariam Savabi, MD, MPH and Brenda Pereda, MD, MS
University of New Mexico, Albuquerque, NM
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
A third of US women have an abortion, often a painful and emotional experience, during their reproductive years. Few studies have examined patients’ experience in abortion care, or providers’ perceptions of the patient experience. Our objective was to better understand what patient needs define a good abortion experience and address disparities in quality abortion care. We conducted interviews with 10 providers and 25 women seeking first-trimester surgical abortions at the University of New Mexico Center for Reproductive Health. Participants underwent a pre-procedure in-person interview as well as a post-procedure phone interview. Interviews were transcribed and coded using Dedoose™. When evaluating perspectives, patients and providers had similar priorities, but organized them in an inverse hierarchy. While providers valued safety and pain control highly, patients instead ranked empathy and a non-judgmental environment as most important. There was also diversity between patients in their threshold of care, indicated by the depth of their expectations. Women and providers valued different but complementary aspects of abortion care, indicating that global clinical care is integral to a positive patient abortion experience. Additionally, poor access to care or restrictive policies in neighboring states may indicate different needs amongst abortion patients.
Clinical medicine applied in public health Provision of health care to the public
Abstract
Integrated Connection to Health Storytelling Network, Health Literacy, and Health Information Behaviors among Residents in South Korea
Jean Lim, DrPH Candidate1, Kenneth K. H. Chui, PhD, MS/MPH1, Keeho Park2 and Yong-Chan Kim, PhD3
(1)Tufts University School of Medicine, Boston, MA, (2)National Cancer Center, Gyeonggi-do, Korea, Republic of (South), (3)Yonsei University, Seoul, Korea, Republic of (South)
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
Health literacy (HL) involves capacity for health problem-solving, which may be strengthened by access to a communication infrastructure for “storytelling” within the community. Based on Communication Infrastructure Theory, the relationships among HL, access to community-level communication resources, and health information-seeking behaviors (HISB) were examined. We accessed in-person interviews conducted in 2012 with 1,500 adults representative of South Korea’s demographics using quota sampling. Independent variables (HL, integrated connection to health storytelling network (ICSN)) and dependent HISB variables (health information resource use, self-efficacy, seeking intention) were measured using existing scales. Functional HL was measured using the Korean Adult HL Scale (31 items). ICSN calculated scores from 16 multiple-choice questions examining connections to interpersonal health storytelling, community organizations, and health media. Composite scores were calculated for dependent variables. Using multivariable linear regression and structural equation modeling, we examined the associations of HL and ICSN with HISB, and the mediating and moderating role of ICSN. After adjusting for demographics and self-rated health, HL was positively associated with health information (HI) self-efficacy (p<0.001) and intention (p<0.05). ICSN was positively associated with HI resource use (p<0.001), self-efficacy (p<0.001), and intention (p<0.001). We observed a synergistic interaction between ICSN and HL on HI resource use (p<0.001), and no significant mediation effect. Individuals well-connected to community organizations, health media, and interpersonal networks are more likely to seek HI from a broader scope of channels, have a higher perception of HI efficacy, and demonstrate stronger intent to seek HI, independent of individual ability to obtain and understand HI.
Assessment of individual and community needs for health education Communication and informatics Social and behavioral sciences Systems thinking models (conceptual and theoretical models), applications related to public health
Abstract
Understanding Precarious Work from a Community Perspective Utilizing Concept Mapping
Marcella Hernandez
University of Illinois at Chicago, Chicago, IL
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
No literature has examined community perception of how work impacts community health. Structural drivers that impact one’s access to opportunity and therefore social position influence who engages in precarious work. Little Village (LV) partners and academics used Concept Mapping (CM) to explore the nature of precarious work and its perceived impact on the health of workers, families and community in LV, a predominantly immigrant, Mexican Chicago community.
Using CM, LV stakeholders, and research partners from the University of Illinois at Chicago School of Public Health’s Center for Healthy Work explored the perceived relationship between work and health in LV. LV residents were engaged in a brainstorming process that responded to a focal question. Responses were reduced to unique statements, which LV participants sorted into groups and rated on community prevalence and health impact. CS Global Max was used for data analysis.
Seventy-five residents participated in Brainstorming, generating 262 ideas. Common themes included work barriers due violence and work as a source of pride. Community and academic researchers reduced the ideas to 55 items for Sorting & Rating (S&R). Seventy-five residents participated in S&R. Common descriptors of grouped statements, visually depicted in cluster maps include abuse, inhibiting social relationships, and work allowing for a better quality of life.
Preliminary results reveal barriers and pathways toward healthy work, community identified capacity to promote worker health, and points of intervention that will prioritize community needs. CM is a well-suited methodology for discerning community ideas and gaining insight on their perceptions on complex phenomena.
Occupational health and safety Planning of health education strategies, interventions, and programs Public health or related research Systems thinking models (conceptual and theoretical models), applications related to public health
Abstract
Marijuana Risk Perceptions are Associated with Past Month Marijuana Use among First Year College Students
Joanne D'Silva, PhD, MPH1, Bradley O. Boekeloo, PhD, ScM2 and Sylvia Quinton, JD3
(1)Minneapolis, MN, (2)University of Maryland College Park, College Park, MD, (3)University of Maryland Eastern Shore, Princess Anne, MD
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
Purpose: Previous research has shown that marijuana use may lead to deleterious mental and physical health outcomes as well as negative academic consequences among young people. The Health Belief Model posits that individuals who perceive they are susceptible to harm will be less likely to engage in risky health behaviors. The purpose of this study was to examine the relationship between marijuana risk perceptions and marijuana use in a sample of first year college students, after controlling for demographic characteristics and other substance use.
Methods: A convenience sample of students (n=213) at a rural, mid-Atlantic historically black university were surveyed. Past 30-day marijuana use, marijuana risk perceptions as well as demographic characteristics and other past 30-day substance use (cigarettes, other tobacco products, alcohol or illegal drug use) were assessed.
Results: Most participants were Black (87.9%) and approximately half (52%) were female. Over a third of participants (35.1%) reported past 30-day marijuana use and a majority (58.4%) reported no or slight risk from using marijuana once or twice weekly. In logistic regression models controlling for demographic characteristics and other substance use, higher marijuana risk perceptions were associated with lower odds of past 30-day marijuana use (OR=0.48, 95% CI=0.33 to 0.72).
Conclusions: Results suggest an inverse relationship between perceived risk and marijuana use. Policy changes in the legalization of marijuana for medical and recreational use have the potential to change perceptions of marijuana risk in the population. Efforts aimed at increasing awareness about known adverse consequences from marijuana use are warranted.
Diversity and culture Planning of health education strategies, interventions, and programs Public health or related public policy
Abstract
Characteristics of University of Florida Family Medicine Patients Frequently Readmitted to the Hospital in 2016
Denny Fe Agana, MPH, CPH, Hannah Crooke, MPH, Lisa Chacko, MD, MPH, Maribeth Porter, MD, MS, Catherine Striley, PhD, MSW, MPE and Peter Carek, MD, MS
University of Florida, Gainesville, FL
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
Background: Readmissions result in negative health outcomes and financial consequences. Understanding risk factors related to readmissions may inform clinicians of patient characteristics associated with such events.
Methods: We conducted a 12-month retrospective chart review of patients readmitted to an inpatient family medicine service. Multinomial logistic regression was used to determine the association between increasing no show clinic visits and increasing cancelled clinic appointments, and number of hospital readmissions. Separate multinomial models were used for each independent variable to address issues of multicollinearity. Number of readmissions was categorized as: 1-2, 3-4, 5-6, >6. Models were controlled for age, race, and gender.
Results: Of the 275 patients included, most were aged 35-64 years (47.3%), white (58.2%), female (56.7%), and Medicare insured (61.8%). In adjusted multinomial regression, there were significantly increased odds of having 5-6 or >6 readmissions for each additional no-show visit (OR= 1.58 95% CI=1.18, 2.11; OR = 1.44 95% CI=1.09, 1.91, respectively) compared to individuals with 1-2 readmissions. The association between 3-4 readmissions and no show visits compared to 1-2 readmissions was non-significant. There were significantly increased odds of having 3-4, or >6 readmissions for each additional cancelled clinic visits (OR= 1.16 95% CI=1.05, 1.29; OR = 1.29 95% CI=1.15, 1.43, respectively) compared to individuals with 1-2 readmissions. The association between 5-6 readmissions and cancelled clinic visits compared to 1-2 readmissions was non-significant.
Conclusions: A high number of no-show visits or cancelled visits may reflect an underlying problem that should trigger increased attention from clinics of these patients.
Clinical medicine applied in public health Epidemiology Planning of health education strategies, interventions, and programs