Seeking Cancer Information: An Appalachian Perspective

There are noted disparities by ethnicity, race, age, gender, and socioeconomic status in the reported use of and access to cancer information. Missing from this list of variables that predict these disparities are specific geographic locales, such as Appalachia, a region recognized as a medically underserved, “special population”. Through a secondary analysis of NCI’s 2003 HINTS dataset, we are able to describe the cancer information-seeking behaviors of Appalachians as compared to non-Appalachians with a focus on actual versus preferential information-seeking behaviors, information-seeking experiences, and demographics. In general, Appalachians and non-Appalachians do not significantly differ in their cancer information-seeking behaviors and experiences. However, there are subtle, important differences related to the use and trust of health care providers and the Internet for cancer information. It is important to understand the effects that geography has not only on health outcomes, but also on access to and use of cancer information

HPV Vaccination Among Young Adult Women: A Perspective From Appalachian Kentucky

INTRODUCTION: Few studies have assessed barriers to human papillomavirus (HPV) vaccination uptake and adherence, particularly among women of Appalachian Kentucky, a population with higher rates of cervical cancer, lower rates of HPV vaccination, and lower socioeconomic status compared with the rest of the nation. The objective of this study was to address women\u27s reasons for declining the HPV vaccine and, among women who initiated the vaccine series, barriers to completion of the 3-dose regimen. METHODS: We recruited 17 women aged 18 to 26 from a Federally Qualified Health Center who participated in in-depth, semistructured telephone interviews. All interviews were audio-recorded and transcribed verbatim; analysis of the interview transcripts was an iterative process conducted by all 3 authors. RESULTS: We identified 3 primary barriers: 1) a knowledge gap wherein women are both uninformed and misinformed about cervical cancer, HPV, and the HPV vaccine, all of which affect vaccination behaviors; 2) environmental and tangible barriers (transportation and prioritizing health over other responsibilities such as child care, work, and school); and 3) ambiguous information sources, which contribute to misinformation and subsequently affect vaccination decisions. CONCLUSION: Health professionals should use clear and purposeful communication about how cervical cancer develops, the purpose and safety of the HPV vaccine, and the necessity of completing the 3-dose series. Health promotion campaigns and services tailored for young women in Appalachian Kentucky that focus on increasing knowledge and eliminating barriers are needed

Providers’ Perspectives on Addressing Health Risk Behaviors and Mental Health among Young Adult Survivors of Childhood Cance

Objectives: We examined healthcare providers’ perspectives on how childhood cancer impacts young adult health behaviors and psychosocial functioning, how healthy lifestyle and psychosocial issues are addressed in this population, challenges related to addressing these issues, and potential resources for addressing them.Methods: In 2012, we recruited 21 healthcare providers (e.g., oncologists, nurses, social workers) who treat young adult survivors of childhood cancer from a children’s hospital and a cancer center in the Southeastern U.S. to complete telephone-based semi-structured interviews.Results: Our sample was an average of 45.95 (SD=7.57) years old, 52.4% female, and 81.0% MDs. Most mentioned that the impact of cancer on health risk behaviors and psychosocial functioning depended on several things including social support and other environmental factors. Participants indicated several general activities and approaches aimed at addressing healthy lifestyles among this population. Participants reported a range of health education, from minimal education to continuous education throughout treatment and survivorship. Providers indicated a team-oriented approach to addressing psychosocial issues and that the survivorship program addressed the complications of obtaining insurance, education and employment, and reproductive health within this population. A major factor was the involvement of the family in addressing these issues. Providers’ challenges in intervening included limited time, resources, financial support, and referral options. Participants suggested resources to address these challenges.Conclusions: Several resources are needed to address the challenges faced by practitioners in addressing young adult survivors’ issues, including physical resources, social support resources, education for patients and healthcare providers, and programs to provide financial support

Health Care Avoidance Among Rural Populations: Results From a Nationally Representative Survey

BACKGROUND: Previous research suggests that certain populations, including rural residents, exhibit health care avoidant behaviors more frequently than other groups. Additionally, health care avoidance is related to sociodemographics, attitudes, social expectations, ability to pay for care, and prior experiences with providers. However, previous studies have been limited to specific geographic areas, particular health conditions, or by analytic methods. METHODS: The 2008 Health Information Trends Survey (HINTS) was used to estimate the magnitude of health care avoidance nationally and, while controlling for confounding factors, identify groups of people in the United States who are more likely to avoid health care. Chi-square procedures tested the statistical significance (P \u3c .05) of bivariate relationships. Multivariable analysis was conducted through a weighted multiple logistic regression with backward selection. RESULTS: For 6,714 respondents, bivariate analyses revealed differences (P \u3c .05) in health care avoidance for multiple factors. However, multiple regression reduced the set of significant factors (P \u3c .05) to rural residence (OR = 1.69), male sex (OR = 1.24), younger age (18-34 years OR = 2.34; 35-49 years OR = 2.10), lack of health insurance (OR = 1.43), lack of confidence in personal health care (OR = 2.24), lack of regular provider (OR = 1.49), little trust in physicians (OR = 1.34), and poor provider rapport (OR = 0.94). CONCLUSION: The results of this study will help public health practitioners develop programs and initiatives targeted and tailored to specific groups, particularly rural populations, which seek to address avoidant behavior, thereby reducing the likelihood of adverse health outcomes

Bark beetle population dynamics in the Anthropocene: Challenges and solutions

Tree-killing bark beetles are the most economically important insects in conifer forests worldwide. However, despite N200 years of research, the drivers of population eruptions and crashes are still not fully understood and the existing knowledge is thus insufficient to face the challenges posed by the Anthropocene. We critically analyze potential biotic and abiotic drivers of population dynamics of an exemplary species, the European spruce bark beetle (ESBB) (Ips typographus) and present a multivariate approach that integrates the many drivers governing this bark beetle system. We call for hypothesis-driven, large-scale collaborative research efforts to improve our understanding of the population dynamics of this and other bark beetle pests. Our approach can serve as a blueprint for tackling other eruptive forest insects

Pathogenic Role of mTORC1 and mTORC2 in Pulmonary Hypertension.

Concentric lung vascular wall thickening due to enhanced proliferation of pulmonary arterial smooth muscle cells is an important pathological cause for the elevated pulmonary vascular resistance reported in patients with pulmonary arterial hypertension. We identified a differential role of mammalian target of rapamycin (mTOR) complex 1 and complex 2, two functionally distinct mTOR complexes, in the development of pulmonary hypertension (PH). Inhibition of mTOR complex 1 attenuated the development of PH; however, inhibition of mTOR complex 2 caused spontaneous PH, potentially due to up-regulation of platelet-derived growth factor receptors in pulmonary arterial smooth muscle cells, and compromised the therapeutic effect of the mTOR inhibitors on PH. In addition, we describe a promising therapeutic strategy using combination treatment with the mTOR inhibitors and the platelet-derived growth factor receptor inhibitors on PH and right ventricular hypertrophy. The data from this study provide an important mechanism-based perspective for developing novel therapies for patients with pulmonary arterial hypertension and right heart failure