Edmir Marrero

The validity of drug use responses in a household survey in Puerto Rico: comparison of survey responses with urinalysis.

AIMS The available evidence suggests that the validity of drug use responses in general population surveys is low. We have conducted a household survey to examine viral infections in the general population of Puerto Rico employing a number of procedures believed to increase the validity of drug use responses, as well as confidentiality and privacy: telling participants of toxicological verification of drug use prior to the interview, ACASI self-interviewing, and interviewing outside households in mobile examination units. METHODS The study employed a stratified cluster sample of 1654 adults 21 to 64 years old, 532 recruited while urine samples were being collected and 1122 recruited after urinalysis was discontinued due to budgetary reasons. RESULTS Drug use rates calculated from participants recruited while urinalysis was being conducted did not vary significantly to those derived from participants recruited after urinalysis was discontinued. Sensitivity of responses of drug use during the last three days was 80.0% for marihuana, 76.2% for cocaine, and 40.0% for heroin. The lower validity of heroin reports did not seem to be the result of underreporting as it was reported by more individuals than the test detected. CONCLUSION We conjecture that the reasonably good validity of the drug use responses might have been the result of the parent study being about a health issue other than drug use, and that interviewing was conducted outside households in mobile units. These findings buttress the value of conducting methodological trials to identify procedures which yield valid responses of drug use.

Prevalence, genotyping, and correlates of anogenital HPV infection in a population-based sample of women in Puerto Rico

Background Oncogenic HPV infection is associated to anogenital cancer. We estimate the prevalence and correlates of anogenital HPV infection among a population-based sample of women aged 16–64 years living in the metropolitan area of Puerto Rico. Methods 564 women completed face-to-face and computer assisted interviews and self-collected anal and cervical specimens. HPV DNA testing used MY09/MY11 consensus HPV L1 primers and beta-globin as an internal control for sample amplification. Positive specimens were typed by dot-blot hybridization. Results Weighted prevalence of cervical, anal, and cervical/anal co-infection was 29.4%, 38.6%, and 17.1%, respectively. The commonest oncogenic HPV types detected in the cervix and anus were: 68 (8% vs. 7%) and 16 (5.5% vs. 5.1%), correspondingly. Having ≥3 lifetime sexual partners (OR: 2.3; 95% CI: 1.5–3.5) and last year anal intercourse (OR: 1.6; 95% CI: 1.1–2.5) increased the odds of anogenital HPV infection. Cervical infection was independently associated to anal infection (OR: 3.0; 95% CI: 2.0–4.6). Conclusions Similar to others, our results confirm the burden of anogenital HPV infection in women and its relationship with sexual behavior. As vaccination increases, future studies should monitor changing trends in HPV infection in this population, and the relationship between anal and cervical HPV-related disease.

Seroprevalence of HPV 6, 11, 16 and 18 and correlates of exposure in unvaccinated women aged 16–64 years in Puerto Rico

Background To understand risk factors for HPV exposure in Puerto Rican women, we evaluated HPV 6, 11, 16, and 18 serology in women aged living in the San Juan metropolitan area. Methods As part of a cross-sectional study, a population-based sample of 524 HPV unvaccinated Hispanic women ages 16–64 years completed face-to-face and computer assisted interviews and provided blood and self-collected anal and cervical specimens. Serology used multiplex virus-like particle based-IgG ELISA and HPV DNA was detected with L1-consensus PCR. Results 32% and 47% were seropositive to HPV types included in the bivalent (16/18) and quadrivalent (6/11/16/18) vaccines, respectively. Type-specific seroprevalence was HPV6 − 29%, HPV11 − 18%, HPV16 − 23%, and HPV18 − 17%; seroprevalence was high in the youngest age-group (16–19: 26–37%). HPV seropositivity was associated with having ≥ 3 lifetime sexual partners (OR=2.5, 95% CI=1.7–3.9) and detection of anogenital HPV DNA (OR=1.8, 95% CI=1.2–2.6). Conclusions The high cumulative exposure of HPV vaccine types 6/11/16/18 in this Hispanic population was influenced by factors related to HPV exposure through sexual behavior. High seroprevalence in the youngest age-group indicates early age of exposure to HPV in Puerto Rico, highlighting the need for HPV vaccination starting prior to age 16.

Same-Sex Behavior and its Relationship with Sexual and Health-Related Practices Among a Population-Based Sample of Women in Puerto Rico: Implications for Cancer Prevention and Control

ABSTRACT This secondary data analysis aimed to estimate the prevalence of same-sex behavior and sexual and health-related practices of a population-based sample (n = 560) of women aged 16–64 years in Puerto Rico (PR). Data collection included interviews and biologic samples. Seven percent of the sample had had sex with other women (WSW). Age-adjusted logistic regression models indicated that WSW had higher odds of history of cancer, having ≥ 7 lifetime sexual partners, using sex toys and sharing them, and use of tobacco and illicit drugs. Future research is needed to address the health needs of WSW, including cancer-related risk factors and sexual practices.

Abstract 3610: Cervical cancer screening and sexual risky behaviors among a population of Hispanic origin.

Proceedings: AACR 104th Annual Meeting 2013; Apr 6-10, 2013; Washington, DC Background: Cervical cancer is the fifth most commonly diagnosed cancer in women living in Puerto Rico (PR). The leading cause of cervical cancer is infection with high-risk types of human papilloma virus (HPV). Thus, women with risky sexual behaviors may be at high risk of HPV infection, which in turn, increase the risk of cervical cancer. Pap-test screening has demonstrated to be effective in reducing the burden of cervical cancer, although its use has been observed to vary among certain population subgroups, including Hispanics. Objective: This study assessed the prevalence of cervical cancer screening utilization and its association with sexual behaviors among a population-based sample of Hispanic women in PR. Methods: This study was a secondary data analysis of the database of an ongoing cross-sectional study of HPV infection in PR (2010-2012). The study group was identified through a complex sampling design of households in the San Juan Metropolitan Area, and included non-institutionalized women aged 16-64 years old residing in this area. The data were collected by means of personalized and computer assisted interviews. Sexual risky behavior was defined as an index that considered the following sexual behaviors: early age of sexual debut (≤15 years), ≥11 lifetime sexual partners and ≥2 sexual partners in the last year. Multivariable logistic regression was used to estimate the odds ratio (OR) to determine the strength of the association between sexual risk behavior and Pap test utilization, after adjusting for socioeconomic characteristics. Results: Mean age of participants was 43.1±13.1 years, 70.5% had achieved less than bachelors degree education and 9.43% had no health care coverage. Overall, 78.9% of respondents reported to have had a Pap test within the last 3 years. Multivariate logistic regression showed that women with two or three risky sexual behaviors were less likely to have had a Pap test within the past 3 years (OR: 0.45, 95% CI: 0.23, 0.88) when compared to those with none or one risky sexual behavior, after adjusting for age, educational attainment, smoking status and STI history. Conclusions: The prevalence of cervical cancer screening in this population is still below Healthy People 2020 recommendations (93%). Our study results also suggest that women with risky sexual behavior at high risk for HPV infection and cervical cancer development) are less likely to use cervical cancer screening. Efforts to promote cervical screening programs should focus on these high risk women, as a method for cervical cancer prevention and control. Citation Format: Daisy Gonzalez, Erick Suarez, Cynthia M. Perez, Marievelisse Soto-Salgado, Edmir Marrero, Ana P. Ortiz. Cervical cancer screening and sexual risky behaviors among a population of Hispanic origin. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 3610. doi:10.1158/1538-7445.AM2013-3610