The Maine Lung Cancer Coalition: A Statewide, Multi-Sector Partnership to Improve Evidence-Based Lung Cancer Prevention & Screening

MLCC has two primary goals: 1. Engage and educate about evidence based lung cancer prevention and screening practices 2. Develop, implement, and evaluate innovative programs to increase access to prevention, screening, and treatment services for all Mainershttps://knowledgeconnection.mainehealth.org/lambrew-retreat-2021/1051/thumbnail.jp

Behavioral Health in Rural America: Challenges and Opportunities [EXECUTIVE SUMMARY]

Full report available at: http://www.rupri.org/wp-content/uploads/Behavioral-Health-in-Rural-America-Challenges-and-Opportunities.pd

Female Age at First Sexual Intercourse by Rural-Urban Residence and Birth Cohort.

BACKGROUND: Previous studies have examined timing of sexual initiation in the United States, but little is known about rural-urban differences in age at first sex. METHODS: We used female respondent data from the National Survey of Family Growth (n = 29,133; 2006-2010 and 2011-2017) to examine age at first vaginal sex with a male partner. We used the Kaplan-Meier estimator and Cox proportional hazard analyses to assess differences in age at first sex by rural-urban residence, overall and stratified by 5-year birth cohorts (1968-1997). Models were adjusted for respondent characteristics and accounted for complex survey design. RESULTS: Overall, rural women experienced first sex earlier compared with urban women (hazard ratio [HR], 1.20; 95% confidence interval [CI], 1.12-1.29). By age 18, 62% of rural women had experienced first sex, compared with 54% of urban women. After adjustment for respondent characteristics, HRs were attenuated, but rural women were still more likely to have experienced first sex compared with urban women (HR, 1.07; 95% CI, 1.01-1.13). In unadjusted models, rural women were more likely to have experienced first sex compared with urban women for most birth cohorts (HRs ranged from 1.14 to 1.32); for only one cohort (1988-1992) was this association found in the adjusted analysis (HR, 1.23; 95% CI, 1.09-1.39). CONCLUSIONS: Women living in rural areas were generally more likely to report first sex at an earlier age compared with urban women, suggesting that delivery of sexual education and reproductive health services for women in the United States may need to take into account rural-urban residence

Behavioral Health in Rural America: Challenges and Opportunities

This paper provides an overview of behavioral health (BH) in rural America. The goal is to help rural leaders and providers understand the issues related to rural mental health (MH) and substance use (SU) and give them resources and tools to develop targeted strategies to address the unique needs of their communities. In the first section, we discuss the prevalence of behavioral health disorders (BHDs) in rural populations generally and among certain high-risk population groups (e.g., veterans, children). We then review what is known about rural access to BH services, focusing on the challenges of providing prevention, treatment, and recovery services in rural areas. The third section focuses on promising program and policy strategies that have been tested in rural communities targeting improvements in rural BH systems. We conclude with a discussion of opportunities for policy and system changes to improve rural BH systems and outcomes. Executive Summary available as a separate document: http://www.rupri.org/wp-content/uploads/Behavioral-Health-in-Rural-America-Challenges-and-Opportunities-Executive-Summary-.pd

Pilot Study of an Encounter Decision Aid for Lung Cancer Screening

The Centers for Medicare and Medicaid Services has mandated in-person shared decision-making (SDM) counseling with the use of one or more decision aids (DAs) prior to lung cancer screening. We developed a single-page, paper-based, encounter DA (EDA) to be used within a clinician-patient encounter for lung cancer screening and conducted a pre-post pilot intervention study to evaluate its feasibility and effects on patient decisional conflict. Patients referred to a pulmonary practice-based lung cancer screening program were surveyed before and after an SDM visit with a pulmonologist, who used the EDA to counsel the patient. Patient knowledge of the mortality benefit from screening and the frequency of abnormal screening test results was evaluated after the visit, while decisional conflict was measured before and after the visit using the Decisional Conflict Scale (DCS). Twenty-three patients participated (mean age = 65.8 years; 43% female; mean smoking history = 57.8 pack-years; 48% currently smoking). Following the visit, 28% of participants correctly understood the mortality benefit of lung cancer screening, while 82% understood the frequency of abnormal screening tests. The mean total DCS score decreased from 35.0 to 0.2 after the visit (p \u3c 0.001). These data suggest that a single-page, paper-based EDA is feasible and potentially effective in reducing decision conflict when used within a SDM visit, although more research is needed to establish the independent effects of the EDA, and future efforts to promote SDM may need to devote greater attention to improving patient understanding of the mortality benefit of screening

Predictors of urinary biomarker concentrations of phthalates and some of their replacements in children in the Project Viva cohort

BACKGROUND: Some phthalates are still widely used in food packaging, toys, and personal care products, and links to adverse health have motivated substitution with replacement chemicals. Few studies have examined patterns and predictors of phthalate replacement biomarkers in children. OBJECTIVE: To examine associations of sociodemographic, dietary, and urine collection characteristics with urinary concentrations of biomarkers of select phthalates and their replacements in mid-childhood. METHODS: We studied 830 children ages 6-10 years in 2007-2010 in a Boston-area cohort. We quantified urinary metabolites and summed their concentrations to calculate biomarkers of the concentrations of ten parent phthalates/replacements. We used linear regression to examine mutually adjusted associations of each predictor with each phthalate biomarker. We used logistic regression to examine predictors of 1,2-cyclohexane dicarboxylic acid, diisononyl ester (DINCH) biomarker detectability. RESULTS: Predictor characteristics explained 25-48% of urinary biomarker variability. Di-2-ethylhexyl terephthalate (DEHTP) biomarker was higher in females (18.7% [95% CI: 0.7, 39.9]), children who consumed more meat and dairy, and samples collected from later years. DINCH biomarker was more detectable in females (odds ratio [OR] 2.1 [95% CI: 1.5, 3.0]) and samples from later years. SIGNIFICANCE: Populations of children with increased urinary concentrations of phthalate and replacement biomarkers can be targeted for future study of sources of exposure, and identifying dietary predictors of biomarkers will directly guide future interventions. IMPACT: Our study uses data from a large cohort that is one of the first to measure DINCH, DEHTP, and metabolites of di-isononyl phthalate and di-isodecyl phthalate. Additionally, we evaluate predictors during mid-childhood when biomarkers might be highest. As the use of replacement phthalates increases, our study is one of the first to examine biomarker patterns and predictors among children

Advancing Tobacco Prevention and Control in Rural America

Commercial tobacco use is the leading cause of preventable disease, disability, and death in the United States. Rural communities continue to bear a disproportionate burden of tobacco-related health harms. In this comprehensive report, the lead authors—members of the Maine Rural Health Research Center and the Muskie School of Public Service at the University of Southern Maine—examine rates and patterns of commercial tobacco use across rural subpopulations; explore aspects of the rural context that may affect tobacco prevention and control efforts; provide an overview of rural tobacco control activities over the past ten years; suggest directions for future research; and offer recommendations for advancing rural tobacco control initiatives. The report also highlights a variety of examples of tobacco prevention and control efforts underway in rural communities across America that can be replicated and scaled to reduce the prevalence of commercial tobacco use and improve public health

Advancing Tobacco Prevention and Control in Rural America: Executive Summary

The objectives of the comprehensive report were to: examine rates and patterns of commercial tobacco use across rural subpopulations; explore aspects of the rural context that may affect tobacco prevention and control efforts; provide an overview of rural tobacco control activities over the past ten years; suggest directions for future research; and offer recommendations for advancing rural tobacco control initiatives. Public health professionals, health department leaders, elected officials, and tobacco control advocates are encouraged read the full report to understand the unique challenges tobacco control programs face in rural communities, identify strategies and interventions that have worked, and review recommendations to improve tobacco control efforts in rural communities across the country