Ann O. Amuta

Health information seeking in the digital age: An analysis of health information seeking behavior among US adults

Abstract We live in a digital age and this has changed the landscape of health information. With the changing US demographic, otherwise acute diseases morphing into chronic diseases as a result of treatment advancements, and evolving health needs of the population, there is need for increase in available and accessible health information. It is estimated that one in three US adults use the internet to diagnose or learn about a health concern. Nevertheless, a nagging question is whether the Web is reducing or creating disparities in health information availability and use for making health decisions. This study examined factors associated with heath information seeking from the internet, traditional media, and health care professionals among a diverse population of US adults. Data for the analysis was from four cycles (2011–2014) of the Health Information National Trends Survey (HINTS), a national survey of US adults. Controlling for age, race/ethnicity, gender, and socioeconomic status (SES), regression analyses were conducted. STATA 13 was used for analyses. Findings indicated that there is a possibility that while the Web is an easily available source of health information, it could also create inequalities in health information accessibility. The Web should not be considered a substitute for using alternative health information sources. Doing so, might create disproportionate access to health information essential for health decisions.

Influence of the Home Food Environment on Children’s Fruit and Vegetable Consumption A Study of Rural Low-Income Families

Background. This investigation sought to identify micro-level built and sociocultural characteristics of a home food environment that have been theoretically linked with fruit and vegetable (F&V) consumption. Method. We examined rural families (n = 298) from the southeastern United States. Hierarchical multiple regression analyses determined the association between the outcome variable (F&V consumption) and micro-level built and sociocultural characteristics of a home food environment. Results. Demographic characteristics were entered at Step 1, explaining 14% of variance in vegetable consumption and 9% in fruit consumption. After entry of sociocultural factors in the home food environment, such as parenting styles and so on, in Block 2, the total variance explained increased by 25% for vegetable consumption and 12% for fruit consumption. Micro-level built environmental factors such as the availability of F&V in the home was entered at Block 3, total variance explained by the model for vegetable consumption was 67%, F(17, 111) = 13.5, p < .001, and for fruit consumption was 57%, F(17, 160) = 12.5, p < .001. Conclusion. F&V availability was the most important variable influencing a child’s consumption of F&V. There are modifiable factors within the rural low-income home that could serve as priorities for intervention to improve F&V consumption.

Risk Perceptions for Developing Type 2 Diabetes among Overweight and Obese Adolescents with and without a Family History of Type 2 Diabetes.

OBJECTIVES Examine risk perceptions among overweight and obese adolescents for developing Type 2 Diabetes (T2D) compared to their peers, in adulthood and in their lifetime. METHODS Participants (N = 319) were overweight/obese college-aged students. Multiple linear regression analyses examined the predictive relationship of the independent variables on comparative, absolute and 5-year perceived risk for developing T2D. RESULTS Female adolescents (β=0.186, p < .05), those with a T2D family history (β=0.147, p < .05) and BMI (β=0.315, p < .05), had a positive statistically significant relationship with comparative, absolute, and 5-year T2D risk perceptions. Although most respondents reported behavioral risk factors for developing T2D, behavioral causal belief had no statistically significant (p > .05) association with personal T2D risk assessment. CONCLUSIONS The at-risk participants in this investigation primarily based their T2D risk assessment on non-modifiable factors, possible undervaluing the influence of behavioral risk and protective factors. Future work should seek to improve awareness of the influence of behavioral factors and also seek to increase the perceived risk of not engaging in protective behaviors such as physical activity and weight management.

Coverage and determinants of childhood immunization in Nigeria: A systematic review and meta-analysis

INTRODUCTION The proportion of fully immunized children in Nigeria is reportedly low. There are concerns over national immunization data quality, with this possibly limiting country-wide response. We reviewed publicly available evidence on routine immunization across Nigeria to estimate national and zonal coverage of childhood immunization and associated determinants. METHODS A systematic search of Medline, EMBASE, Global Health and African Journals Online (AJOL) was conducted. We included population-based studies on childhood immunization in Nigeria. A random effects meta-analysis was conducted on extracted crude rates to arrive at national and zonal pooled estimates for the country. RESULTS Our search returned 646 hits. 21 studies covering 25 sites and 26,960 children were selected. The estimated proportion of fully immunized children in Nigeria was 34.4% (95% confidence interval [CI]: 27.0-41.9), with South-south zone having the highest at 51.5% (95% CI: 20.5-82.6), and North-west the lowest at 9.5% (95% CI: 4.6-14.4). Mothers social engagements (OR=4.0, 95% CI: 1.9-8.1) and vaccines unavailability (OR=3.9, 95% CI: 1.2-12.3) were mostly reported for low coverage. Other leading determinants were vaccine safety concerns (OR=3.0, 95% CI: 0.9-9.4), mothers low education (OR=2.5, 95% CI: 1.8-3.6) and poor information (OR=2.0, 95% CI: 0.8-4.7). CONCLUSION Our study suggests a low coverage of childhood immunization in Nigeria. Due to the paucity of data in the Northern states, we are still uncertain of the quality of evidence presented. It is hoped that this study will prompt the needed research, public health and policy changes toward increased evenly-spread coverage of childhood immunization in the country.

The Effect of Cancer Information Seeking on Perceptions of Cancer Risks, Fatalism, and Worry Among a U.S. National Sample

ABSTRACT Background: Information seeking is crucial in the health behavior context. Cancer information seeking may play a key role in individuals’ perceptions and subsequent health behaviors. Purpose: The purpose of this study is to investigate the influence of cancer information seeking on perceptions of cancer worry, fatalism and risk. Methods: Data from the 2014 U.S. Health Information and National Trends Survey were used. Fatality index, lifetime risk perceptions, and cancer worry were dependent variables. Each model included cancer information seeking as the independent variable, controlling for the demographic variables (age, gender, education, income, ethnicity, and marital status), body mass index (BMI), and cancer family history. Results: A majority were females (59.76%; n = 1856). The mean age was 53 and most participants were white (52.19%). A majority had a bachelor’s degree or higher (40.11%), and 40.2% were actively seeking information on cancer. Results show that information seeking was a significant predictor of lifetime risk perceptions (β = 0.079, R2 = 0.105, P < .001) and cancer worry (β = 0.129, R2 = 0.081, P < .001). Discussion: Active cancer information-seekers were more likely to worry about getting cancer and perceive that they had a greater chance to get cancer. Translation to Health Education Practice: Health Educators are encouraged to pay closer attention to how cancer information is framed to ensure that information elicits health-enhancing attitudes and behaviors.

Gender Differences in Type 2 Diabetes Risk Perception, Attitude, and Protective Health Behaviors: A Study of Overweight and Obese College Students

Background: Obesity prevalence among children and adolescents has dramatically increased in the past decade and has resulted in higher rates of type 2 diabetes mellitus (T2DM) among adolescents. Purpose: To examine whether there are gender differences in T2DM risk perception, attitude toward T2DM protective behaviors, physical activity, and meeting the recommended fruit and vegetable daily intake among adolescents at risk for T2DM. Methods: Overweight and obese students were included in this study (n = 319). Linear regression analyses were used for all models. Analyses were carried out using SPSS (Ver 20.0). Gender differences in the regression models were considered statistically significant at P < .05. Results: Females showed significantly higher positive attitudes toward eating healthy foods such as fruits and vegetables (B = 9.089, β = 0.337, P = .000). Females were more likely to consume more cups of fruit and vegetables than males (B = 1.650, β = 0.118, P = .036) and more likely to use calorie information when ordering/buying food compared to males (B = .765, β = 0.245, P = .000). However, males were more likely to engage in moderate physical activity (PA; B = − 22.076, β = − 0.110, P = .050) and vigorous PA (B = − 45.145, β = − 0.235, P = .000) compared to females). Conclusion: To effectively develop health promotion initiatives for students/adolescents, it is important to examine gender differences and factors that influence them. Translation to Health Education Practice: Findings from this study suggest the need for Health Education Specialists to consider gender variations when developing and evaluating T2DM prevention health programs for youth.

Impact of Type 2 Diabetes Threat Appraisal on Physical Activity and Nutrition Behaviors among Overweight and Obese College Students.

OBJECTIVE We examined the impact of threat appraisal (TA) on Type 2 diabetes (T2D)-related protective behaviors among high-risk college students. METHODS Using a Web-based survey, we collected data from 319 overweight or obese undergraduate students attending one of 4 Texas colleges/universities. Hierarchical multiple regression analyses determined the association between the outcome variable, fruits and vegetables (F&V) consumption and physical activity (PA), and TA. RESULTS Demographic characteristics were entered at step 1, explaining 7% of variance in F&V consumption and 6% in PA. After TA was entered in block 2, the total variance explained changed by only .008% for F&V consumption and .009% for PA. CONCLUSIONS TA did not predict T2D protective behaviors and reduced variability in the model. Being female, as well as having a T2D family history, was significantly associated with increased TA. Results can inform the planning, implementing, and evaluating of health promotion programs.

Influence of Family History of Cancer on Engagement in Protective Health Behaviors

Background: Approximately 1580 people die from cancer each day. Family history is highlighted as an especially important indicator of cancer risk. Purpose: To determine whether having a family member with cancer influences preventive behaviors (e.g., smoking, physical activity, and screenings). Methods: We conducted a secondary data analysis (regression) of the 2014 Health Information National Trends Survey (HINTS). Results: The sample was primarily married (48%) females (61.37%; n = 1614). Most participants had a family member diagnosed with cancer (64.33%; n = 1661). Family history did not significantly influence routine screening behavior (β = 0.016, odds ratio [OR] = 1.068, 95% confidence interval [CI], 0.751–1.520, P = .708); lifetime smoking status (β = 0.04, OR = 1.19, 95% CI, 0.84–1.69, P = .312); current smoking status (β = − 0.022, OR = 0.955, 95% CI, 0.433–2.105, P = .907); or physical activity behavior (β = − 0.04, 95% CI, − 23.13 to 5.15, P = .207). Discussion When compared to those without a positive family history, respondents with a history of cancer did not engage in significantly different levels of protective lifestyle behaviors. Translation to Health Education Practice: Family history status is an influential factor on ones risk of disease and perhaps should be emphasized and incorporate into health education interventions.

Avoiding Inferential Errors in Public Health Research: The Statistical Modelling of Physical Activity Behavior

Background: A review of the health behavior literature on the statistical modeling of days of physical activity (PA) indicates that in many instances linear regression models have been used. It is inappropriate statistically to model a count dependent variable such as days of physical activity with Ordinary Least Squares (OLS). Many count variables have skewed distributions, and, also, have a preponderance of zeroes. Count variables should not be treated as continuous and unbounded. If OLS is used, estimations of the regression will frequently turn out to be inefficient, inconsistent and biased, and such outcomes could well have incorrect impacts on health programs and policies. Methods: We considered three statistical methods for modelling the distribution of days of PA data for respondents in the 2013 Health Information Trends Survey (HINTS). The three regression models analyzed were: Ordinary Least Squares (OLS), Negative Binomial (NBRM), and Zero-inflated Negative Binomial (ZINB). We used the exact same predictor variables in the three models. Our results illustrate the differences in the results. Results: Our analyses of the PA data demonstrated that the ZINB model fits the observed PA data better than either the OLS or the NBRM models. The coefficients and standard errors differed in the zero-inflated count models from the other models. For instance, the ZINB coefficient for the association between income and PA behavior was not statistically significant (p>0.05), whereas in the NBRM and in the OLS models, it was statistically significant (p<0.05). Conclusions: The inappropriate use of regression models could well lead to wrong statistical inferences. Our analyses of the number of days of moderate PA demonstrated that the ZINB count model fits the observed PA data much better than the OLS model and the NBRM.

Estimating the incidence of breast cancer in Africa: a systematic review and meta-analysis

Background Breast cancer is estimated to be the most common cancer worldwide. We sought to assemble publicly available data from Africa to provide estimates of the incidence of breast cancer on the continent. Methods A systematic search of Medline, EMBASE, Global Health and African Journals Online (AJOL) was conducted. We included population- or hospital-based registry studies on breast cancer conducted in Africa, and providing estimates of the crude incidence of breast cancer among women. A random effects meta-analysis was employed to determine the pooled incidence of breast cancer across studies. Results The literature search returned 4648 records, with 41 studies conducted across 54 study sites in 22 African countries selected. We observed important variations in reported cancer incidence between population- and hospital-based cancer registries. The overall pooled crude incidence of breast cancer from population-based registries was 24.5 per 100 000 person years (95% confidence interval (CI) 20.1-28.9). The incidence in North Africa was higher at 29.3 per 100 000 (95% CI 20.0-38.7) than Sub-Saharan Africa (SSA) at 22.4 per 100 000 (95% CI 17.2-28.0). In hospital-based registries, the overall pooled crude incidence rate was estimated at 23.6 per 100 000 (95% CI 18.5-28.7). SSA and Northern Africa had relatively comparable rates at 24.0 per 100 000 (95% CI 17.5-30.4) and 23.2 per 100 000 (95% CI 6.6-39.7), respectively. Across both registries, incidence rates increased considerably between 2000 and 2015. Conclusions The available evidence suggests a growing incidence of breast cancer in Africa. The representativeness of these estimates is uncertain due to the paucity of data in several countries and calendar years, as well as inconsistency in data collation and quality across existing cancer registries.