Disparities in Access to After-Hours Care in the U.S.: A National Study

After-hours care provides timely access to continuity of care for chronic illnesses and episodic care for acute illness. Lack of timely access to primary care services is one of the main drivers of emergency department overuse. Our aim was to examine disparities in access to after-hours care based on race, income, geographic location, type of insurance, and health care setting. We used data from the 2010 Health Tracking Household Survey. Multivariable logistic regression was used to assess disparities in access to after-hours care. We found disparities by type of insurance, geographic location, and type of health care setting. People with Medicaid were less likely than those with private insurance to have access to after-hours care (aOR 0.67, 95% CI, 0.53-0.88). Those in non-metropolitan areas were less likely to have access to after-hours care (aOR 0.73, 95% CI, 0.61-0.89) as compared to those living in large metropolitan areas. In comparison to the Northeast census region, access to after-hours was less likely in the Midwest (aOR 0.60, 95% CI, 0.49-0.73), South (aOR 0.40, 95% CI, 0.33-0.48), and West region (aOR 0.46, 95% CI, 0.37-0.57). We found no evidence of disparities based on sex, race/ethnicity, or income. With the increasing need of after-hours care, policymakers should plan to provide incentives to providers to offer after-hours care

Changing Urbanization Patterns in US Lung Cancer Mortality, 1950–2007

This study examined disparities in lung cancer mortality rates among US men and women in metropolitan and non-metropolitan areas from 1950 through 2007. Annual age-adjusted mortality rates were calculated for men and women in metropolitan and non-metropolitan areas, and differences in mortality rates were tested for statistical significance. Log-linear regression was used to model annual rates of change in mortality over time, while Poisson regression was used to estimate relative risk after adjusting for age, sex, deprivation, and urbanization levels. Urbanization patterns in lung cancer mortality changed dramatically between 1950 and 2007. Compared to men in metropolitan areas, men aged 25–64 years in non-metropolitan areas had significantly lower lung cancer mortality rates from 1950 to 1977 and men aged ≥65 years in non-metropolitan areas had lower mortality rates from 1950 to 1985. Differentials began to reverse and widen by the mid-1980s for men and by the mid-1990s for younger women. In 2007, compared to their metropolitan counterparts, men aged 25–64 and ≥65 years in non-metropolitan areas had 49 and 19% higher lung cancer mortality and women aged 25–64 and ≥65 years in non-metropolitan areas had 32 and 4% higher lung cancer mortality, respectively. Although adjustment for deprivation levels reduced excess lung cancer mortality risk among those in non-metropolitan areas, significant rural–urban differences remained. Rural–urban patterns reversed because of faster and earlier reductions in lung cancer mortality among men and women in metropolitan areas. Temporal trends in rural–urban disparities in lung cancer mortality appear to be consistent with those in smoking

Do Life Style Factors And Socioeconomic Variables Explain Why Black Women Have A Remarkably Higher Body Mass Index (BMI) Than White Women In The United States? Findings From The 2010 National Health Interview Survey

Objective: There are marked inequalities in body mass index (BMI), overweight, and obesity across ethnic groups. We sought to examine the extent to which lifestyle factors and socioeconomic variables explain the higher BMI in Black women compared to White women in the United States. Methods: We used data from the 2010 National Health Interview Survey (NHIS) and limited the sample to non-Hispanic Black and non-Hispanic White women (n = 9,491). We employed normal regression and compared the association of race with BMI before and after adjusting for lifestyle factors (diet, physical activity, smoking, and drinking) and socioeconomic variables (education, ratio of income to poverty threshold, occupation, and home ownership). Data analysis was performed in 2012. Results: The difference between the BMI of Black and White women decreased from 2.91 to 2.17 Kg/m2 (i.e. a decrease of 27.2%) after adjusting for lifestyle factors and socioeconomic variables. Multivariate results also showed that higher consumption of fruit/vegetables and beans, lower consumption of red meat and sugar sweetened beverages, physical activity, smoking, regular drinking, and higher socioeconomic status were associated with lower BMI. Conclusions: Lifestyle factors and socioeconomic variables explain about a quarter of the BMI inequality between Black and White women. Thus, interventions that promote healthy eating and physical activity among Blacks as well as social policies that ameliorate socioeconomic inequalities between races might be able to reduce the current BMI inequality between Black and White women

Socioeconomic, Rural-Urban, and Racial Inequalities in US Cancer Mortality: Part I—All Cancers and Lung Cancer and Part II—Colorectal, Prostate, Breast, and Cervical Cancers

We analyzed socioeconomic, rural-urban, and racial inequalities in US mortality from all cancers, lung, colorectal, prostate, breast, and cervical cancers. A deprivation index and rural-urban continuum were linked to the 2003–2007 county-level mortality data. Mortality rates and risk ratios were calculated for each socioeconomic, rural-urban, and racial group. Weighted linear regression yielded relative impacts of deprivation and rural-urban residence. Those in more deprived groups and rural areas had higher cancer mortality than more affluent and urban residents, with excess risk being marked for lung, colorectal, prostate, and cervical cancers. Deprivation and rural-urban continuum were independently related to cancer mortality, with deprivation showing stronger impacts. Socioeconomic inequalities existed for both whites and blacks, with blacks experiencing higher mortality from each cancer than whites within each deprivation group. Socioeconomic gradients in mortality were steeper in nonmetropolitan than in metropolitan areas. Mortality disparities may reflect inequalities in smoking and other cancer-risk factors, screening, and treatment

Socioeconomic Differences in the Effectiveness of the Removal of the “Light” Descriptor on Cigarette Packs: Findings from the International Tobacco Control (ITC) Thailand Survey

Many smokers incorrectly believe that “light” cigarettes are less harmful than regular cigarettes. To address this problem, many countries have banned “light” or “mild” brand descriptors on cigarette packs. Our objective was to assess whether beliefs about “light” cigarettes changed following the 2007 removal of these brand descriptors in Thailand and, if a change occurred, the extent to which it differed by socioeconomic status. Data were from waves 2 (2006), 3 (2008), and 4 (2009) of the International Tobacco Control (ITC) Thailand Survey of adult smokers in Thailand. The results showed that, following the introduction of the ban, there was an overall decline in the two beliefs that “light” cigarettes are less harmful and smoother than regular cigarettes. The decline in the “less harmful” belief was considerably steeper in lower income and education groups. However, there was no evidence that the rate of decline in the “smoother” belief varied by income or education. Removing the “light” brand descriptor from cigarette packs should thus be viewed not only as a means to address the problem of smokers’ incorrect beliefs about “light” cigarettes, but also as a factor that can potentially reduce socioeconomic disparities in smoking-related misconceptions

Barriers of Colorectal Cancer Screening in Rural USA: A Systematic Review

INTRODUCTION: Colorectal cancer (CRC) screening rates are lower in rural areas in the USA. To guide the design of interventions to improve CRC screening, a systematic review was conducted to identify CRC screening barriers for rural populations. METHODS: A search was conducted in four literature databases - Medline, CINAHL, Embase, and Scopus - for articles from 1998 to 2017 that examine CRC screening barriers in rural areas. This review included a total of 27 articles reporting perceived CRC screening barriers by rural residents or providers or examining factors associated with CRC screening of rural populations in the USA. RESULTS: The most frequently reported barriers were high screening cost and lack of insurance coverage, embarrassment or discomfort undergoing screening, lack of knowledge or perceived need on CRC screening, and lack of physician recommendation. These barriers were confirmed in quantitative studies examining their association with CRC screening status. Age, marital status, and race/ethnicity were the most frequently reported factors associated with CRC screening in rural areas. Lack of prevention attitude toward cancer, perceived lack of privacy, shortage of specialists, and distance to test facilities were reported as rural-specific barriers for CRC screening. CONCLUSIONS: Main barriers for CRC screening at both the individual and healthcare system level are identified in rural areas and they are in line with those found in urban areas in general. In particular, lack of prevention attitude toward cancer, perceived lack of privacy, shortage of specialists, and distance to test facilities disproportionately hamper CRC screening for rural Americans

Smoking cessation intervention delivered by social service organisations for a diverse population of Australian disadvantaged smokers: A pragmatic randomised controlled trial

OBJECTIVES There remains a need to identify effective smoking cessation interventions in severely disadvantaged populations. This trial aimed to examine the effectiveness of an intervention (Call it Quits) developed to promote smoking cessation and delivered by community social service case-workers. METHODS Call it Quits was a pragmatic, parallel randomised trial of a case-worker delivered smoking cessation intervention conducted in a non-government community social service organisation in New South Wales (NSW), Australia. Adult smokers requiring financial assistance were randomly assigned to the five-session Call it Quits intervention or usual care control group. Of the 618 eligible individuals, 300 were randomised to the intervention group, of whom 187 (62%) consented and 318 were randomised to the control group, of whom 244 (77%) consented, resulting in 431 participants. The primary outcome measure was self-reported continuous abstinence up to 6-month follow-up with biochemical verification. Primary analysis was performed using all the available data from participants under the assumption the data is missing completely at random, followed by sensitivity analyses. RESULTS No statistically significant differences in the primary outcome were found (1.4% in the control group versus 1.0% in the intervention group, OR = 0.77, p = 0.828). CONCLUSIONS A multi-component smoking cessation intervention delivering motivational interviewing-based counselling and free NRT by a trained case-worker within a community social service setting was not effective at achieving abstinence in a highly disadvantaged sample of smokers but increased attempts to stop and led to a reduction in number of cigarettes smoked daily.This study was funded by the National Health and Medical ResearchCouncil (NHMRC) of Australia (631055

Comparing socially disadvantaged smokers who agree and decline to participate in a randomised smoking cessation trial

Objectives: This study examined sociodemographic, smoking and psychosocial characteristics associated with consent to participate in a smoking cessation trial for socially disadvantaged smokers. Design: Baseline data were collected prior to seeking consent for the Call it Quits, a randomised controlled trial. Setting: An Australian social and community service organisation. Sociodemographic, smoking and psychosocial characteristics were compared between smokers who agreed or declined to participate. Participants: Of the 584 smokers invited to participate, 431 (74%) consented and 153 (26%) declined. Results: Logistic regression modelling indicates the ORs of participation were twice as high for those reporting 'high' motivation to quit compared to the 'moderate' motivation group, and five times higher than the 'low' motivation group ( p=0.007). The ORs of consenting were higher for those with a preference for gradual reduction in cigarettes in quit attempts compared with 'no preference'. The ORs were lower for those reporting 'don't know' regarding their enjoyment of smoking compared to 'not at all' enjoying smoking, and reporting that fewer of their family or friends smoked compared to 'most or all'. Conclusions: This study is the first to examine the characteristics of socially disadvantaged smokers who consent or decline to participate in a smoking cessation trial. Low-income smokers who are motivated to quit, are not enjoying smoking, had family or friends who smoked, and who are interested in gradual cessation approaches may be more likely to participate in a smoking cessation trial

The Impact of Body Mass Index and Sociodemographic Factors on Moderate-to-Vigorous Physical Activity and Sedentary Behaviors of Women With Young Children: A Cross-Sectional Examination

OBJECTIVES: Moderate-to-vigorous physical activity provides multiple benefits to women after childbirth. To achieve these benefits, the recommendation that adults obtain, 150 min of moderate-to-vigorous physical activity per week and reduce sedentary behaviors, also applies to women in the post-partum phase of the life span. However, research examining the moderate-to-vigorous physical activity and sedentary behaviors of women with young children (0-2 years) is limited. A greater understanding of these behaviors from a nationally representative sample is needed. Therefore, the primary objective of this study was to determine the levels of moderate-to-vigorous physical activity and sedentary behaviors of a nationally representative sample of women with young children within the United States. A secondary objective was to examine the influence of body mass index and sociodemographic factors on these behaviors. METHODS: Cross-sectional data from four cycles of the National Health and Nutrition Examination Survey (2007-2008, 2009-2010, 2011-2012, and 2013-2014) were used for analysis. Descriptive statistics were calculated and a generalized linear model was used to investigate associations between mean minutes of moderate-to-vigorous physical activity, sedentary activity, body mass index, and sociodemographic variables. DISCUSSION: Women with young children (n = 477) obtained 634 min in moderate-to-vigorous physical activity per week and this was positively associated with having a higher income (p \u3c 0.001) and the number of children in the home (p \u3c 0.001). In total, 62% of women were meeting the World Health Organization guidelines for aerobic activity. Lower odds of achieving guidelines was associated with being Black (p = 0.004), Mexican American (p = 0.009), or married (p = 0.042) compared with being White or not married. Finally, women accumulated ~5 h of sedentary activity per day, with higher levels associated with race (p = 0.005), education (p = 0.022), and number of children within the home (p \u3c 0.001). Research efforts should continue to focus on strategies to help non-adhering women with young children achieve the physical activity recommendations and reduce time spent in sedentary behaviors