Elinita Pollard

Purpose: Cancer survivors and those with cardiovascular diseases have an increased risk of developing colorectal cancer and breast cancer. Undergoing colorectal cancer screening and mammogram uptake within the recommended intervals have the potential to improve early detection. However, the potential impact of cancer history and cardiovascular disease on colorectal cancer screening and mammogram uptake remains unexamined. Methods: We conducted a cross-sectional analysis of 2019, 2021, and 2023 National Health Interview Survey data. Our outcomes of interest were up-to-date colorectal cancer screening and mammogram uptake. Our exposures of interest were cancer history and cardiovascular disease. We used weighted multivariable logistic regressions to examine these associations and adjusted for sociodemographic characteristics, healthcare access, and the year respondents took the survey. Results: Most respondents had up-to-date colorectal cancer screening (73.1%) and mammogram uptake (77.8%). Most respondents did not report a history of cancer (colorectal cancer screening sample: 85.1%, mammogram uptake sample: 84.6%) or cardiovascular disease (colorectal cancer screening sample: 87.7%, mammogram uptake sample: 90.1%). Having a history of cancer was associated with increased odds of having up-to-date colorectal cancer screening (OR, 1.74, 95% CI, 1.56–1.95). However, respondents with cardiovascular disease, but no cancer history, had decreased odds of mammogram uptake (OR: 0.79, 95% CI: 0.68–0.91). Discussion: The history of cancer was associated with increased colorectal cancer screening uptake. Contrarily, cardiovascular diseases were associated with decreased mammogram uptake. Generally, healthcare providers should emphasize the importance of up-to-date colorectal cancer screening and mammogram uptake. However, our findings suggest that primary care and educational initiatives tailored toward those with cardiovascular disease that aim to improve mammogram uptake are needed.

Perinatal cardiovascular disease accounts for nearly one-third of pregnancy-related deaths, with nearly 70% of these deaths preventable with appropriate cardio-obstetric care. The objective is to assess whether socioeconomic disadvantage, utilizing area deprivation index national and state rankings as a proxy, contributes to a higher risk of CV disease during the perinatal period. A single-site retrospective cohort study of 388 electronic health records patients seen at a novel cardio-obstetrics program between June 2022 and May 2024 was conducted. The main exposure was ADI state rankings, and the primary outcome of interest was diagnosis of perinatal CV disease, with secondary measures including preeclampsia, hypertension, and peripartum cardiomyopathy. Multivariable logistic regression models were utilized to examine the association between ADI and perinatal CV disease. National ADI ranking was associated with an increased odds of developing preeclampsia (OR: 2.56, 95% CI: 1.12–5.89) and HTN (OR: 2.37, 95% CI: 1.19–4.72). Socioeconomic disadvantage during the perinatal period is associated with a statistically significant risk of CV disease, including preeclampsia, hypertension, and peripartum cardiomyopathy, as well as any CV diagnosis in general.

Although breastfeeding provides health benefits to both mother and child, this study aimed to explore whether disparities in breastfeeding continue to exist, particularly among non-Hispanic Black (NHB) mothers and children. We performed a cross-sectional analysis among 19,830 children in the United States (US) using the National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2020. Breastfeeding initiation and duration rates increased overall from 1999 to 2020. Children who were ever breastfed were more likely to have higher body weight, older mothers, mothers who did not smoke during pregnancy, a higher family poverty–income ratio (PIR), food security, mothers in excellent health, and mothers who had not seen a mental health professional in the past year. NHB children were breastfed at significantly lower rates and for shorter duration than non-Hispanic White (NHW), Mexican, Other Hispanic, and Other/Multi-Racial children. NHB children were breastfed less than other racial groups, including minority Mexican children with similar average PIR, suggesting a possible unique experience for NHB mothers and children. Strategies include impacting social norms and offering culturally tailored breastfeeding supports. The provision of structural supports to remove barriers to breastfeeding is a social justice issue. Breastfeeding confers health benefits to mother and child, and disparities exist among mothers and children, particularly among NHB mothers and children. The current study provides data on the most recent breastfeeding trends, showing that these disparities by race/ethnicity are present. Interestingly, even among Mexican participants of a similar PIR, NHB children were still breastfed less.

Background: Kentucky is within the top five leading states for breast cancer mortality nationwide. This study investigates the association between neighborhood socioeconomic disadvantage and breast cancer outcomes, including surgical treatment, radiotherapy, chemotherapy, and survival, and how associations vary by race and ethnicity in Kentucky. Methods: We conducted a retrospective cohort analysis using data from the Kentucky Cancer Registry for patients with breast cancer diagnosed between 2010 and 2017, with follow-up through December 31, 2022. We linked Kentucky Cancer Registry data with census tract data to examine the relationship between area deprivation index (ADI) and breast cancer outcomes. Logistic regression and Cox proportional hazards models analyzed binary outcomes and time-to-event data, respectively. Results: Women in the most disadvantaged (ADI fourth quartile) neighborhoods were more likely to be diagnosed at later stages (OR, 1.26; 95% confidence interval, 1.12–1.41) and 34% more likely to die from breast cancer (HR, 1.34; 95% confidence interval, 1.14–1.57) after adjusting for age, race, tobacco use, tobacco pack-years, marital status, insurance status, family history, stage at diagnosis, breast cancer subtype, and residence in Appalachia when compared with women living in the least disadvantaged neighborhoods (ADI first quartile). Conclusions: Women in disadvantaged neighborhoods had significantly higher odds of late-stage diagnosis and breast cancer death, regardless of race, indicating that neighborhood factors contribute to breast cancer disparities. Impact: Socioeconomic and neighborhood factors may contribute to breast cancer outcomes, suggesting the necessity for targeted interventions. Future research should explore the effectiveness of such interventions and investigate additional social determinants contributing to disparities.

Purpose: The human papillomavirus (HPV) vaccine was recently approved for 27–45-year-olds. We examined the association between HPV vaccination status and having an up-to-date Papanicolaou (Pap) test for 27–45-year-old women across racial/ethnic groups. Methods: We conducted a cross-sectional analysis using 2019–2022 Behavioral Risk Factor Surveillance System data. We performed weighted multivariable logistic regressions to examine the association between being unvaccinated, initiating, and completing the HPV vaccine series and Pap test uptake. Results: Among 7,052 women, non-Hispanic White (NHW) women had the highest rate of HPV vaccine series completion (14.0%). Non-Hispanic Black (NHB) had the lowest rate of HPV vaccine series completion (9.2%) and the highest rate of up-to-date Pap tests (71.2%). Non-Hispanic Other (NHO) women had the lowest rate of up-to-date Pap tests (52.1%). Completing the HPV vaccine series was associated with increased odds of having an up-to-date Pap test (odds ratio [OR]: 1.66 95% confidence interval [CI]: 1.23–2.24). Among Hispanic and NHW women, HPV vaccine series completion was associated with increased odds of up-to-date Pap testing (Hispanic: OR: 2.16, 95% CI: 1.02–4.58; NHW: OR: 1.49, 95% CI: 1.01–2.21). HPV vaccine series initiation was associated with up-to-date Pap tests for NHB (OR: 2.75, 95% CI: 1.19–6.34) and NHO women (OR: 3.15, 95% CI: 1.56–6.37). Conclusions: Unvaccinated women had decreased odds of up-to-date Pap testing. Shared clinical decision-making should be utilized to help 27–45-year-old women decide if they want to receive the HPV vaccine; culturally tailored efforts should be made to improve utilization of Pap testing across racial/ethnic groups.

Cultural humility is important in supervision; however, studies have primarily sampled White supervisees. Racially and ethnically minoritized trainees experience microaggressions during their training, yet cross-racial supervision is less often studied. We examined a moderated mediation model to test whether the supervisory working alliance mediated the relationship between frequency of racial microaggressions and satisfaction with supervision, and whether the impact of racial microaggressions on the supervisee and supervisor cultural humility moderated the relationship between racial microaggression frequency and the supervisory working alliance. In a sample of supervisees of color (N = 102; majority cisgender women, 86.2%, and heterosexual, 59.8%; 35.3% Black/African American, 28.4% Asian/Pacific Islander, 18.6% Hispanic/Latine) receiving clinical supervision from White supervisors, we found that racial microaggression frequency was negatively associated with satisfaction with supervision, and this relationship was fully accounted for by the supervisory working alliance. Racial microaggressions in supervision were found to be detrimental to the supervisory working alliance, which was then related to lower satisfaction with supervision. Further, racial microaggression impact and cultural humility moderated the relationship between racial microaggression frequency and the supervisory working alliance; this relationship was strongest when racial microaggression impact was high and cultural humility was average or high. The social bond hypothesis suggests we are more likely to allow ourselves to be vulnerable when we assess cultural humility to be high. We posit that the observed moderation effect may be due to supervisees experiencing greater shock when experiencing racial microaggressions from supervisors whom they perceived to be culturally humble. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Background: This study assessed the association between cardiovascular disease (CVD), the leading cause of death in the United States, among parents and child mental health. Methods: Our sample included 9076 children aged 6 to 17 years. Data were pooled from the 2016–2018 waves of the National Health Interview Survey. We fitted a logistic regression to obtain the odds ratios in favor of child mental health problems for parental CVD. We also fitted a multinomial logistic regression to obtain the odds in favor of the severity of mental health problems (i.e., minor, definite, and severe). Results: The adjusted odds of facing difficulties for a child of a parent with CVD were 1.64 (95% CI: 1.28–2.11) times that of their peers whose parents did not have CVD. The adjusted relative risk of facing minor and definite difficulties for a child of a parent with CVD were 1.48 (95% CI: 1.13–1.94) and 2.25 (95% CI: 1.47–3.46) times that of their peers of parents without CVD. Conclusions: The results suggest a strong association between child mental health and parental cardiovascular morbidity, demonstrating the need for the development or adaptation of existing public health interventions to facilitate mental health support for children of parents with CVD.

Marital disruption defined as widowhood, divorce, or separation, has adverse consequences for women’s health and wellbeing. Extant evidence, however, is primarily available for older women or in developed country settings. Consequences of marital disruption for younger women in the developing countries is relatively less visited. The aim of this cross-sectional study is to assess whether maritally disrupted women of reproductive age (18–49 years) had differential risk of tobacco-use compared to their married counterparts. Using nationally representative data from India, we estimated multivariable logistic regressions to obtain the odds in favor of tobacco-use for maritally disrupted women. We found that compared to women remained in marriage, maritally disrupted women were 1.5 times (95% CI: 1.4–1.6) more likely to consume tobacco. The higher risk of tobacco-use of maritally disrupted women was evident in both younger (age 18–34) and older (age 35–49) cohorts. The results were robust across urban and rural areas, high- and low- education groups, and poor- and non-poor households. The higher odds of tobacco-use among maritally disrupted women persisted even after accounting for household fixed effects. The study findings thus, have implications for strengthening targeted tobacco control policies and health promotion among maritally disrupted women in low-and-middle income countries.