Health Literacy and Cancer Prevention: It’s Not What You Say It’s What They Hear

Background: A growing body of literature documents the relationship between health literacy and important health behaviors and outcomes. Most research to date has focused on print literacy–few studies have examined literacy with respect to spoken information (“spoken health literacy”). We sought to examine the extent to which responses to physician advice about cancer prevention and screening were associated with spoken health literacy. Methods: Participants listened to 3 simulated physician-patient discussions addressing: 1) Prostate Specific Antigen (PSA) testing; 2) tamoxifen for breast cancer prevention; and 3) colorectal cancer (CRC) screening. The physician provided information on risks and benefits but did not endorse one course of action. Post-vignette questions assessed understanding and reactions to the physician’s advice. Participants had previously completed the Cancer Message Literacy Test-Listening (CMLT-L), a measure of spoken health literacy. Bivariate analyses examined the relationship between CMLT-L scores and comprehension, attitudes, and behavioral intentions. Results: Four hundred thirty-eight adults from 3 HMORN sites participated. Comprehension: Post-vignette comprehension scores were correlated with CMLT-L scores (r=0.62, p Discussion: The ability to understand spoken information is a critical component of health literacy. In this study, spoken health literacy influenced patients’ comprehension of, and reaction to spoken health information provided by a physician. The findings that participants scoring in the lowest quartile on the CMLT-L were more likely to respond favorably to physician advice on cancer prevention but were less likely to comprehend content of the vignettes, may indicate that physician mention of a prevention service is interpreted as endorsement of a prevention service in the absence of a full understanding of its risks and benefits

Guillain-Barré Syndrome, Influenza Vaccination, and Antecedent Respiratory and Gastrointestinal Infections: A Case-Centered Analysis in the Vaccine Safety Datalink, 2009–2011

Background: Guillain-Barré Syndrome (GBS) can be triggered by gastrointestinal or respiratory infections, including influenza. During the 2009 influenza A (H1N1) pandemic in the United States, monovalent inactivated influenza vaccine (MIV) availability coincided with high rates of wildtype influenza infections. Several prior studies suggested an elevated GBS risk following MIV, but adjustment for antecedent infection was limited. Methods: We identified patients enrolled in health plans participating in the Vaccine Safety Datalink and diagnosed with GBS from July 2009 through June 2011. Medical records of GBS cases with 2009–10 MIV, 2010–11 trivalent inactivated influenza vaccine (TIV), and/or a medically-attended respiratory or gastrointestinal infection in the 1 through 141 days prior to GBS diagnosis were reviewed and classified according to Brighton Collaboration criteria for diagnostic certainty. Using a case-centered design, logistic regression models adjusted for patient-level time-varying sources of confounding, including seasonal vaccinations and infections in GBS cases and population-level controls. Results: Eighteen confirmed GBS cases received vaccination in the 6 weeks preceding onset, among 1.27 million 2009–10 MIV recipients and 2.80 million 2010–11 TIV recipients. Forty-four confirmed GBS cases had infection in the 6 weeks preceding onset, among 3.77 million patients diagnosed with medically-attended infection. The observed-versus-expected odds that 2009–10 MIV/2010–11 TIV was received in the 6 weeks preceding GBS onset was odds ratio = 1.54, 95% confidence interval (CI), 0.59–3.99; risk difference = 0.93 per million doses, 95% CI, −0.71–5.16. The association between GBS and medically-attended infection was: odds ratio = 7.73, 95% CI, 3.60–16.61; risk difference = 11.62 per million infected patients, 95% CI, 4.49–26.94. These findings were consistent in sensitivity analyses using alternative infection definitions and risk intervals for prior vaccination shorter than 6 weeks. Conclusions: After adjusting for antecedent infections, we found no evidence for an elevated GBS risk following 2009–10 MIV/2010–11 TIV influenza vaccines. However, the association between GBS and antecedent infection was strongly elevated

Determinants of plasma Leptin and age at menarche in adolescent girls in Hawaii

Ph.D. University of Hawaii at Manoa 2010.Includes bibliographical references.This study investigates the association of the Leptin (LEP) and Leptin receptor (LEPR) polymorphisms LEP A19G, LEP G-2548A and LEPR Q223R with plasma leptin concentration, body fat and age at menarche (AAM). The study was part of a larger cohort study that followed 349 multiethnic adolescent girls (ages 9-14yr at baseline) and an additional 180 girls at exam 3 in Hawaii (Female Adolescent Maturation Study). Anthropometry was obtained by measurement, Tanner stages by clinical examination, dietary intake by 3-day diet record and physical activity by a standardized questionnaire. DNA was obtained from mouthwash or blood and was genotyped using a fluorescent 5' endonuclease assay and the ABI FAST 7900HT Real-Time PCR System for allelic discrimination. Dual energy X ray Absorptiometry (DXA) was used to determine body fat mass. The study did not show association between LEP/LEPR variants and plasma leptin. However, the association between plasma leptin and body fat measures (measured using both DXA and anthropometry) was substantiated. A difference in LEPR rare homozygote genotype (AA) and the common homozygote genotype (GG) in DXA trunkto-periphery fat ratio (TPFR) was found (girls with LEPR Q223R AA genotype had lower TPFR compared to GG). It was also found that protein intake (adjusted for BMI) was negatively associated with plasma leptin level. In a COX regression model, girls with AG genotype for LEP G-2548A reached menarche earlier than the AA genotype. The study also substantiated the evidence of heavier and taller girls reaching menarche early. Importantly, this study demonstrated these associations in understudied girls of Asian White ancestry. This present study provides new information on the LEP/LEPR genetic variants, body fat and age at menarche in an Asian White population

Bisphosphonate Drug Holiday and Fracture Risk

Background/Aims: Among women with ≥ 3 years exposure to bisphosphonates (BPs), we compared the incidence of fragility fractures in those who discontinued BPs for ≥ 12 months (drug holiday) to those who continued to use BPs (persistent use). Methods: This retrospective cohort study included women aged ≥ 45 years who initiated BP use from four Kaiser Permanente regions between January 1, 1998, and December 31, 2009. Drug holiday was defined as ≥ 12 months with BP use at 0% adherence. Persistent use status required ongoing use at ≥ 50% adherence. The primary outcome of interest was the first occurrence of an incident clinical osteoporosis-related fragility fracture, identified from the electronic medical record (EMR) via ICD-9-CM codes. All subjects were followed until fracture, disenrollment from the health plan, death, or December 31, 2012. From the EMR, we collected information on the following potential confounders and effect modifiers: race/ethnicity, age, body mass index, comorbidities, history of previous fragility fracture, lowest T-score prior to cohort entry, fall risk, 10-year fracture risk, and prior/concomitant use of bone-active medications. Persistent users and drug holiday subjects were compared with regard to several demographic and clinical characteristics. Time-varying Cox proportional hazards models were used to compare osteoporosis-related fracture incidence between the two groups. Results: The cohort of 28,620 women, observed for 111,997 person-years, included 17,123 (59.8%) persistent BP users and 11,497 (40.2%) drug holiday subjects. The drug holiday group had fewer comorbidities, higher baseline T-scores, and lower fracture and fall risk scores. A total of 3,571 osteoporosis-related fractures were observed. The unadjusted rate ratio (RR) for any osteoporosis-related fractures for drug holiday compared to persistent use was 0.87 (95% confidence interval [CI]: 0.81–0.94), but was 1.0 (95% CI: 0.9–1.2) for hip fractures only. The time-varying models suggested no differences in fracture risk (hazard ratio [HR]: 0.90, 95% CI: 0.80–1.00) after adjustment for baseline fall and fracture risk, comorbidities and other bone-active medication use. Similarly, no difference in hip fracture risk was observed (HR: 0.84, 95% CI: 0.68–1.03). Discussion: Women who undertake a holiday from BP use are not at greater risk of osteoporosis-related fragility fractures, nor hip fractures specifically, than are women who continue to use BPs persistently

Hepatitis A and B immunity and vaccination in chronic hepatitis B and C patients in a large United States cohort

BACKGROUND: Hepatitis A and B vaccines are effective in preventing superinfection and sequelae in patients with chronic hepatitis B or C. We describe immunity and vaccination against hepatitis A and B in chronic hepatitis patients from the US Chronic Hepatitis Cohort Study. METHODS: We identified chronic hepatitis B and C patients with healthcare utilization during 2006-2008 and 12 months of enrollment. We used electronic laboratory records to determine immunity and medical and billing records for vaccination history. Immunity against hepatitis A was defined by positive hepatitis A antibody or documented vaccination. Immunity against hepatitis B was defined as hepatitis B surface antibody level ≥10 mIU/mL or core antibody positive, or by documented vaccination. RESULTS: Among 1635 chronic hepatitis B patients, 978 (59.8%) were immune or vaccinated against hepatitis A, 122 (7.5%) had negative hepatitis A antibody tests, and 535 (32.7%) had no testing or vaccination record. Among 5328 chronic hepatitis C patients, 2998 (56.3%) were immune or vaccinated against hepatitis A, 659 (12.4%) had negative hepatitis A antibody tests, and 1671 (31.4%) had no testing or vaccination record. Additionally, 3150 (59.1%) chronic hepatitis C patients were immune or vaccinated against hepatitis B, 1003 (18.8%) had a negative test result, and 1175 (22.1%) were neither tested for nor vaccinated against hepatitis B. CONCLUSIONS: Approximately 40% of chronic hepatitis B and C patients are susceptible to or have no documented immunity or vaccination against hepatitis A or hepatitis B. Clinicians should consider antibody testing and vaccination for this vulnerable population