Jennifer Tsui

Clinical and Epidemiologic Characteristics Cannot Distinguish Community-Associated Methicillin-Resistant Staphylococcus aureus Infection from Methicillin-Susceptible S. aureus Infection: A Prospective Investigation

BACKGROUND Community-associated (CA) methicillin-resistant Staphylococcus aureus (MRSA) infection has become common worldwide. Some researchers have argued that empirical therapy for MRSA should be given only to patients with suspected CA S. aureus infections who have risk factors for acquisition of MRSA. However, there are no prospective data examining this approach. METHODS We prospectively enrolled consecutive patients who were hospitalized with S. aureus infection, administered a detailed questionnaire, and collected clinical and microbiological information. RESULTS Of the 280 consenting patients, 180 were adults with CA S. aureus infection. Among these subjects, 108 (60%) had MRSA infection, and 78 (40%) had methicillin-susceptible S. aureus (MSSA) infection. MRSA infection was associated with younger age (P<.0001); skin/soft-tissue infection (P=.015); snorting/smoking illegal drugs (P=.01); recent incarceration (P=.03); lower comorbidity index (P=.01); more frequent visits to bars, raves, and/or clubs (P=.03); and higher frequency of laundering clothes in hot water (P=.05). However, the sensitivity, specificity, and predictive values for these factors for discriminating CA-MRSA infection from CA-MSSA infection were relatively poor. Post-hoc modeling revealed that, even in a 10% (i.e., low) MRSA prevalence population, patients lacking the 3 strongest MRSA risk factors would still have a 7% posttest probability of MRSA. Most MRSA strains belonged to the ST-8/USA300 genotype, contained SCCmec type IV, and shared virulence factors commonly found in the ST1:USA400 clone. MSSA strains were genotypically heterogeneous. CONCLUSIONS We found that clinical and epidemiological risk factors in persons hospitalized for CA S. aureus infection cannot reliably distinguish between MRSA and MSSA. Our findings have important implications for the choice of empirical antibiotic therapy for suspected S. aureus infections and for infection control.

Understanding Suboptimal Human Papillomavirus Vaccine Uptake Among Ethnic Minority Girls

Background: The introduction of human papillomavirus (HPV) vaccines represents a breakthrough in the primary prevention of cervical cancer. However, little is known about vaccination uptake and correlates among low-income, ethnic minority, and immigrant populations in the U.S. who may benefit most from the vaccine. Methods: Telephone interviews (N = 490) were conducted in six languages between January and November 2009 among mothers of vaccine-eligible girls (ages 9–18) using the Los Angeles County Department of Public Health, Office of Womens Health service referral hotline. HPV and vaccine awareness, knowledge, beliefs, barriers, and daughters vaccine receipt were assessed. Results: The sample consisted of low-income, uninsured, ethnic minority, and immigrant women. Only 29% of daughters initiated the vaccine and 11% received all three doses. No ethnic differences were observed in initiation or completion rates. Ethnic differences were observed in HPV awareness, perceived risk, and other vaccine-related beliefs. The strongest predictor of initiation was vaccine awareness (OR = 12.00). Daughters age and reporting a younger acceptable age for vaccination were positively associated with initiation. Mothers of unvaccinated girls reported lacking information about the vaccine to make a decision (66%) and not knowing where they could obtain the vaccine (74%). Conclusion: Vaccination rates in this sample were lower than state and national estimates, and were associated with low levels of vaccine awareness. Interventions, including culturally targeted messaging, may be helpful for enhancing HPV–vaccine knowledge, modifying vaccine-related beliefs and increasing uptake. Impact: Our findings provide valuable guidance for developing interventions to address suboptimal HPV vaccination in high-risk groups. Cancer Epidemiol Biomarkers Prev; 20(7); 1463–72. ©2011 AACR.

Interview language: a proxy measure for acculturation among Asian Americans in a population-based survey.

We examined health status and access to care among Asian Americans by the following acculturation indicators: nativity, percent lifetime in the US, self-rated English proficiency, and interview language, to assess whether any measure better distinguishes acculturation. Data from the 2003 California Health Interview Survey were used to study the sample of 4,170 US-born and foreign-born Asians by acculturation indicators. We performed t-tests to compare differences in demographics, health status and behaviors, and access to care between the foreign-born and US-born Asians, and between various classifications within foreign-born and the US-born Asian group. Our results showed that foreign-born Asians who interviewed in English more closely resembled US-born Asians than foreign-born Asians who interviewed in languages other than English. Compared to interview language, dichotomizing the sample by other acculturation indicators showed smaller differences between the divided groups. Interview language may serve as a better measure for acculturation especially among foreign-born populations with a high proportion of limited English proficiency. In immigrant public health research studies, interview language may be used as an important covariate for health disparities.

The Change From Brand-Name to Generic Aromatase Inhibitors and Hormone Therapy Adherence for Early-Stage Breast Cancer

BACKGROUND Nonadherence to hormonal therapy is common and is associated with increased copayment amount. We investigated the change in adherence after the introduction of generic aromatase inhibitors (AIs) in 2010. METHODS Using deidentified pharmacy and claims data from OptumInsight, we identified women older than 50 years on brand-name AIs (BAIs) and/or generic AIs (GAIs) for early breast cancer between January 1, 2007 and December 31, 2012. Clinical, demographic, and financial variables were evaluated. Adherence was defined as a medication possession ratio (MPR) 80% or greater. RESULTS We identified 5511 women, 2815 (51.1%) on BAI, 1411 (25.6%) on GAI, and 1285 (23.3%) who switched from BAI to GAI. The median 30-day copayment was higher for BAI (

Comparative Effectiveness of Upfront Treatment Strategies in Elderly Women with Ovarian Cancer

33.3) than for GAI (

Household Net Worth, Racial Disparities, and Hormonal Therapy Adherence Among Women With Early-Stage Breast Cancer

9.04). In a multivariable Cox-proportional hazard analysis, women who took GAI were less likely to discontinue therapy (hazard ratio [HR] = 0.69, 95% confidence interval [CI] = 0.57 to 0.84) compared with BAI. Discontinuation was positively associated with a higher monthly copayment of

Human Papillomavirus Vaccine Use Among Adolescent Girls and Young Adult Women: An Analysis of the 2007 California Health Interview Survey

15 to

Disparities in cancer screening in individuals with a family history of breast or colorectal cancer

30 (HR = 1.21, 95% CI = 1.01 to 1.44) and more than

Cervical cancer screening among Thai women in Northern California.

30 (HR = 1.49, 95% CI = 1.23 to 1.80) compared with less than

Proximity to safety-net clinics and HPV vaccine uptake among low-income, ethnic minority girls.

15. In a multivariable logistic regression analysis, adherence (medication possession ratio ≥ 80%) was positively associated with GAI use (odds ratio = 1.53, 95% CI = 1.22 to 1.91) compared with BAI and inversely associated with increased monthly copayment. In addition, adherence was associated with a high annual income of more than